Key result
Sacubitril/valsartan linked to a ~37% improvement in RV-PA coupling and lower albumin-bilirubin scores in HFrEF.
Why the study?
Although sacubitril/valsartan improves LV function in HFrEF, its effects on RV-PA coupling (TAPSE/PASP) and ALBI score remained to be assessed.
Does sacubitril/valsartan improve right ventricular-pulmonary artery coupling and albumin-bilirubin score in Chinese patients with HFrEF and right ventricular dysfunction?
Observational (n=305)
No
Does sacubitril/valsartan improve right ventricular-pulmonary artery coupling and albumin-bilirubin score in Chinese patients with HFrEF and right ventricular dysfunction?
Sacubitril/valsartan therapy for 1 year is associated with significant improvements in right ventricular-pulmonary artery coupling and liver function (ALBI score) in patients with HFrEF and right ventricular dysfunction.
Answers are grounded in this paper and cite their sources.
Improvements in RV-PA coupling and ALBI score are hypothesis-generating; randomized trials needed before considering practice change in HFrEF.
OBJECTIVE: Impaired right ventricular (RV)-pulmonary arterial (PA) coupling, calculated by measuring the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), can be used as an early indicator of right ventricular dysfunction (RVD) in patients with heart failure with a reduced ejection fraction (HFrEF). Patients suffering from HFrEF experience improvements in left ventricular (LV) function through the administration of sacubitril/valsartan therapy. In addition, the albumin-bilirubin (ALBI) score was associated with the fluid overload status and adverse clinical outcomes in patients with heart failure. This study aimed to assess whether angiotensin receptor-neprilysin inhibitor (ARNI) affects the TAPSE /PASP in patients with HFrEF, and whether there is a correlation between changes in the ALBI score and ARNI treatment. METHODS: A retrospective observational study was conducted on 305 patients with HFrEF and RVD who were hospitalized between June 2020 and December 2021. One year after treatment, laboratory test results, ALBI score, transthoracic echocardiography (TTE), New York Heart Association classification, Minnesota Living with Heart Failure Questionnaire scores and changes in relevant variables were reevaluated. RESULTS: Compared to before sacubitril/valsartan treatment, the ALBI was found to be significantly reduced after one year of follow-up (-2.42 ± 0.37 vs. -2.51 ± 0.32, p < 0.001). Additionally, A significant improvement was demonstrated in the following echocardiography parameters assessing RV function after 1 year of treatment with sacubitril/valsartan: TAPSE (15 ± 1 vs. 18 ± 2 mm, p < 0.001), PASP (45 ± 8 vs. 40 ± 9 mmHg, p < 0.001), pulmonary artery diastolic pressure (PADP) (22 ± 4 vs. 19 ± 4 mmHg, p < 0.001), RV-PA coupling (0.35 ± 0.08 vs. 0.48 ± 0.12, p < 0.001), and RV s'(8.7 ± 2.2 vs. 9.5 ± 2.6 cm/s, p < 0.001). Multivariate analysis showed that the improvement of RV-PA coupling was associated with baseline PASP (r: -0.45, p < 0.001) and PADP (r: -0.45, p < 0.001). CONCLUSIONS: Sacubitril/valsartan improves RV-PA conjugation in patients with RVD and HFrEF, and has a positive impact on the ALBI score by improving liver function in patients with HFrEF.
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Shi et al. (2025) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) and right ventricular dysfunction (n=305). Sacubitril/valsartan vs. Baseline (Pre-treatment) was evaluated on Right ventricular-pulmonary arterial (RV-PA) coupling (TAPSE/PASP ratio) (p=<0.001). Sacubitril/valsartan significantly improved right ventricular-pulmonary arterial coupling (from 0.35 to 0.48) and reduced the albumin-bilirubin score after one year in patients with HFrEF.
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