March 30, 2022Open Access

Hemodynamic Effects of Sacubitril/Valsartan in Patients with Reduced Left Ventricular Ejection Fraction Over 24 Months: A Retrospective Study

MAMohammad AbumayyalehHeidelberg University JDJonathan DemmerBangor University CKCarina KrackHeidelberg University

Structured PICO

Does sacubitril/valsartan improve echocardiographic hemodynamic parameters and reduce hospitalizations in patients with HFrEF?

Population

240 patients with HFrEF (LVEF ≤40%, NYHA class II or higher despite optimal medical treatment, with ICD or CRT), median age 66.9 years, 79.6% male, treated at a single center in Germany.

Intervention

Sacubitril/valsartan initially 24/26 mg twice daily, titrated to 97/103 mg twice daily over 3-6 weeks, for 24 months.

Outcome

Echocardiographic parameters (LVEF, PAPsys, TAPSE, valvular insufficiency), all-cause hospitalization, and congestion rate at 24-month follow-up.surrogate

In a real-world cohort of HFrEF patients, sacubitril/valsartan was associated with sustained improvements in LVEF and pulmonary pressures, as well as reduced hospitalization and congestion rates over 24 months.

Abstract

BACKGROUND: The effects of sacubitril/valsartan in patients with chronic heart failure with reduced ejection fraction (HFrEF) were recently reported. However, the hemodynamic impact of this well-established treatment in patients with HFrEF has been poorly systematically researched. AIM: We aimed to investigate the hemodynamic effects of sacubitril/valsartan among patients with HFrEF. METHODS: Between 2016 and 2020, we retrospectively collected data for patients with HFrEF treated at the University Medical Center Mannheim, Germany. Data for 240 patients with HFrEF were available. We systematically analyzed echocardiographic parameters, all-cause hospitalization, and congestion rate. RESULTS: The left ventricular ejection fraction (LVEF) improved from a median (minimum; maximum) of 28% (3; 65) before initiation of sacubitril/valsartan to a median of 34% (13; 64) at 24-month follow-up (p < 0.001). Systolic pulmonary atrial pressure (PAPsys) decreased from a median of 30 mmHg (13; 115) to 25 mmHg (20; 80) at 24-month follow-up (p = 0.005). The median (minimum; maximum) tricuspid annular plane systolic excursion improved from 17 mm (3; 31) at baseline to 20 mm (9; 30) at 12-month follow-up (p = 0.007). The incidence of severe and moderate mitral, tricuspid, and aortic valvular insufficiency improved after treatment. Hospitalization and congestion rates reduced at 24-month follow-up. The mortality rate in echocardiographic and functional nonresponders was higher than in responders (12.1 vs. 5.2%; p = 0.1 and 11.3 vs. 3.1%; p = 0.01, respectively). CONCLUSION: Follow-up 24 months after starting treatment with sacubitril/valsartan revealed sustained improvements in echocardiographic parameters, including LVEF, PAPsys, and cardiac valvular insufficiency. Rates of all-cause hospitalization and congestion had decreased significantly at follow-up. The mortality rate was higher in echocardiographic and functional nonresponders.

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