Sacubitril/Valsartan Improves Functional Capacity and Reverses LV Remodeling in Obese Patients with Hypertrophic HFpEF: A Randomized Open-Label Study

Figures

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  Figure 1. Flow chart of patient enrolment. DST, diastolic stress test; HFpEF, heart failure with preserved ejection fraction; LVH, left ventricular hypertrophy; RAAS, renin–angiotensin–aldosterone system.

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  Figure 2. (a) Individual and mean changes from baseline (95% CI) in the 6-min walk distance, and (b) bicycle exercise duration in both study groups. Circles represent individual changes, the squares indicate the means, and the error bars indicate the 95% CIs. Sac/Val, sacubitril/valsartan; 6MWDT, 6-min walk test distance.

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  Figure 3. (a) Individual and mean changes from baseline (95% CI) in the LA volume index, (b) PASP, (c) LA reservoir strain, (d) SRIVR, and (e) LV mass index in both study groups. Circles represent individual changes, the squares indicate the means, and the error bars indicate the 95% CIs. LA, left atrial; LV, left ventricular; PASP, pulmonary artery systolic pressure; RVOT, right ventricular outflow tract; Sac/Val, sacubitril/valsartan; SRIVR, global strain rate during the isovolumic relaxation period.

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  Figure 4. (a) The mean and individual changes in the E/e′ ratio, (b) E velocity, and (c) e′ velocity at rest and during cycle exercise at baseline and after 6 months in both study groups. The bars indicate the medians, the squares indicate the means, the markers (error bars) indicate the interquartile ranges or 95% confidence intervals, and circles indicate the individual changes. DST, diastolic stress test; E, early inflow velocity; e′, averaged annulus relaxation velocity; Sac/Val, sacubitril/valsartan.

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  Figure 5. (a) The mean and individual changes from baseline in NT-proBNP, (b) hsCRP, and (c) osteopontin blood levels in both study groups. The bars indicate the medians, the squares indicate the means, the markers (error bars) indicate the interquartile ranges or 95% confidence intervals, and circles indicate the individual changes. hsCRP, high-sensitivity C-reactive protein; NT-proBNP, N-terminal pro-brain natriuretic peptide; Sac/Val, sacubitril/valsartan.

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  Figure 6. The effect of different doses of Sac/Val on key clinical and echocardiographic parameters in HFpEF patients with overweight/obesity and LV hypertrophy. The data are presented as percentage changes from baseline. Bars and squares indicate mean changes, while markers (error bars) indicate 95% confidence intervals. DBP, diastolic blood pressure; E, early inflow velocity; e′, averaged annulus relaxation velocity; LAVI, left atrial volume index; LVMI, left ventricular mass index; NT-proBNP, N-terminal pro-brain natriuretic peptide; PASP, pulmonary artery systolic pressure; Sac/Val, sacubitril/valsartan; SBP, systolic blood pressure; 6MWTD, 6-min walk test distance.

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  Figure 7. The effect of Sac/Val on key clinical and echocardiographic parameters in HFpEF patients depending on the severity of LVH. The data are presented as percentage changes from baseline. Bars and squares indicate mean changes, while markers (error bars) indicate 95% confidence intervals. E, early inflow velocity; e′, averaged annulus relaxation velocity; LAVI, left atrial volume index; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; NT-proBNP, N-terminal pro-brain natriuretic peptide; PASP, pulmonary artery systolic pressure; Sac/Val, sacubitril/valsartan; 6MWTD, 6-min walk test distance.