Key result
Transition from an ACEI or ARB to sacubitril/valsartan significantly reduced mean pulmonary artery pressure by a median of 3.6 mmHg within 1 to 5 days in patients with heart failure with reduced ejection fraction.
Why the study?
Natriuretic peptides exert direct effects on the pulmonary vasculature, but the effect of sacubitril/valsartan on pulmonary artery pressure has not been fully defined.
Does transition to sacubitril/valsartan acutely reduce pulmonary artery pressures in patients with HFrEF and a CardioMEMS sensor?
Observational (n=18)
Yes
Does transition to sacubitril/valsartan acutely reduce pulmonary artery pressures in patients with HFrEF and a CardioMEMS sensor?
Transitioning from an ACEI or ARB to sacubitril/valsartan in HFrEF patients is associated with an acute, significant reduction in pulmonary artery pressures.
Sacubitril/valsartan was associated with reduced mean PAP; hypothesis-generating and requires prospective confirmation before practice change.
AIMS: Sacubitril/valsartan combines renin-angiotensin-aldosterone system inhibition with amplification of natriuretic peptides. In addition to well-described effects, natriuretic peptides exert direct effects on pulmonary vasculature. The effect of sacubitril/valsartan on pulmonary artery pressure (PAP) has not been fully defined. METHODS AND RESULTS: This was a retrospective case-series of PAP changes following transition from angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) to sacubitril/valsartan in patients with heart failure reduced ejection fraction and a previously implanted CardioMEMS™ sensor. Pre-sacubitril/valsartan and post-sacubitril/valsartan PAPs were compared for each patient by examining averaged consecutive daily pressure readings from 1 to 5 days before and after sacubitril/valsartan exposure. PAP changes were also compared between patients based on elevated trans-pulmonary gradients (trans-pulmonary gradient ≥ 12 mmHg) at time of CardioMEMS™ sensor implantation. The cohort included 18 patients, 72% male, mean age 60.1 ± 13.6 years. There was a significant decrease in PAPs associated with transition from ACEI/ARB to sacubitril/valsartan. The median (interquartile range) pre-treatment and post-treatment change in mean, systolic and diastolic PAPs were -3.6 (-9.8, -0.7) mmHg (P < 0.001), -6.5 (-15.0, -2.0) mmHg (P = 0.001), and -2.5 (-5.7, -0.7) (P = 0.001), respectively. The decrease in PAPs was independent of trans-pulmonary gradient (F(1,16) = 0.49, P = 0.49). CONCLUSIONS: In this retrospective case series, transition from ACEI/ARB to sacubitril/valsartan was associated with an early and significant decrease in PAPs.
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Tran et al. (2021) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=18). Sacubitril/valsartan vs. Pre-sacubitril/valsartan (ACEI or ARB) was evaluated on Change in mean pulmonary artery pressure (PAMP) (Median change -3.6 mmHg, p=<0.001). Transition from an ACEI or ARB to sacubitril/valsartan significantly reduced mean pulmonary artery pressure by a median of 3.6 mmHg within 1 to 5 days in patients with heart failure with reduced ejection fraction.
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