What is the clinical evidence from this study?

Study design: Observational. Population: Chronic heart failure with reduced ejection fraction (HFrEF) (n=60). Intervention: Sacubitril/valsartan vs. Baseline. Primary outcome: Tricuspid annular plane systolic excursion (TAPSE) (p=<0.001).

February 25, 2020Open Access

Sacubitril/valsartan improves right ventricular function in a real-life population of patients with chronic heart failure: The Daunia Heart Failure Registry

Q: What are the key findings of this study?

In a real-world registry of patients with chronic heart failure, 12 months of sacubitril/valsartan therapy significantly improved right ventricular function, increasing TAPSE from 16.5 mm to 17.8 mm.

Key Result

In a real-world registry of patients with chronic heart failure, 12 months of sacubitril/valsartan therapy significantly improved right ventricular function, increasing TAPSE from 16.5 mm to 17.8 mm.

Study Design

Type

Observational (n=60)

Structured PICO

Does sacubitril/valsartan improve right ventricular function in patients with chronic heart failure with reduced ejection fraction?

Population

60 consecutive patients with HFrEF (LVEF ≤ 35%) in NYHA functional class II-III, mean age 66 ± 9 years, 88% male, enrolled in the Daunia Heart Failure Registry (Italy). Key inclusion criteria: systolic blood pressure ≥ 100 mmHg, eGFR ≥ 30 mL/min/1.73 m2, potassium levels ≤ 5.4 mmol/l, and treated with stable ACE-inhibitor or angiotensin receptor antagonist doses for at least 6 months.

Intervention

Sacubitril/valsartan therapy for 12 months

Outcome

Right ventricular function assessed by echocardiography (Pulmonary artery systolic pressure [PAsP] and Tricuspid annular plane systolic excursion [TAPSE]) at 12 monthssurrogate

In a real-world cohort of patients with HFrEF, sacubitril/valsartan therapy was associated with significant improvements in right ventricular function (TAPSE and PAsP) that were proportional to baseline dysfunction.

Main Result

Absolute Event Rate: 17.8% vs 16.5%

p-value: p=<0.001

Limitations

Small number of patients enrolled
Observational nature of the study

Abstract

Previous studies and case-series showed improvement in left ventricular (LV) function and reverse remodeling after sacubitril/valsartan therapy in real-world studies. We therefore aimed to evaluate whether also right ventricular (RV) function may improve after sacubitril/valsartan therapy. Sixty consecutive patients with chronic heart failure and NYHA class II-III were followed up for 12 months after therapy with sacubitril/valsartan. Left and (RV) function was assessed at baseline and after 12 months of therapy. At 12-month control, therapy with sacubitril/valsartan was associated with a significant improvement in a series of echo parameters: LVEF (p < 0.05), LV end-systolic volume (p < 0.01), left atrium area (p < 0.05). Right ventricular echo parameters were also improved after sacubitril/valsartan therapy: PAsP (31.0 ± 12.8 vs 34.7 ± 12.5 mmHg, p < 0.05), TAPSE (17.8 ± 3.9 vs 16.5 ± 4.0 mm, p < 0.001); mean PAsP reduction was 3.7 ± 11.4 mmHg (-6.3 ± 37.7%), mean TAPSE increase 1.3 ± 2.5 mm (+9.5 ± 15.7%). Indexed (%) improvement in PAsP (r 0.33, p < 0.01) and TAPSE (r −0.42, p < 0.01) values were proportional to baseline levels. Improvement in PAsP and TAPSE were independent of left ventricular improvements except for PAsP and end-systolic volumes (r 0.44, p < 0.01). In a real world scenario, sacubitril/valsartan was associated with an improved RV function.

AI에게 질문

Bookmark

View Full Paper