Key result
Transition to Sacubitril/Valsartan significantly reduced median mean pulmonary artery pressure from 33 mm Hg to 27 mm Hg in patients with HFpEF and pulmonary hypertension.
Why the study?
HFpEF patients with pulmonary hypertension face particularly high morbidity and mortality, but the effect of sacubitril/valsartan in this subgroup was unknown.
Does transitioning to sacubitril/valsartan reduce invasive pulmonary pressures in patients with HFpEF and pulmonary hypertension?
Observational (n=18)
No
Does transitioning to sacubitril/valsartan reduce invasive pulmonary pressures in patients with HFpEF and pulmonary hypertension?
Absolute Event Rate: 27% vs 33%
p-value: p=<0.05
Transitioning from ACEi/ARB to sacubitril/valsartan significantly improves invasive pulmonary hemodynamics and NYHA functional class in patients with HFpEF and pulmonary hypertension.
May reduce pulmonary pressures in HFpEF-PH; hypothesis-generating and requires prospective randomized confirmation before practice change.
Objectives: Although the PARAGON-HF trial failed to reach its primary endpoint, subgroups of patients with heart failure with preserved ejection fraction (HFpEF) still appear to benefit from Sacubitril/Valsartan therapy. As HFpEF patients with pulmonary hypertension display a specifically high mortality and morbidity, we evaluated the effect of Sacubitril/Valsartan in this subgroup of HFpEF patients. Methods: In this retrospective case-series of 18 patients with HFpEF and pulmonary hypertension, right heart catheterisation (RHC) for determination of invasive pulmonary pressure were performed at baseline (pre-Sacubitril/Valsartan) and 99 (71–156) days after transition from angiotensin-converting enzyme inhibitors and angiotensin receptor blockers to Sacubitril/Valsartan (post-Sacubitril/Valsartan). Results are given as median and interquartile range. Results: After conversion to Sacubitril/Valsartan, RHC showed significantly reduced pulmonary artery pressure (PAP) and mean pulmonary capillary wedge pressure (PCWP) compared to pre-Sacubitril/Valsartan [PAP systolic/diastolic/mean 44 (38–55)/15 (11–20)/27 (23–33) mm Hg vs. 51 (41–82)/22 (13–29)/33 (28–52) mm Hg, p < 0.05 and p < 0.01, respectively; PCWP 16 (12–20) mm Hg vs. 22 (15–27) mm Hg, p < 0.05]. Median Sacubitril/Valsartan dosage was 24/26 mg BID (24/26 BID−49/51 mg BID). Clinically, New York Heart Association functional class improved in 12 of the 18 patients ( p < 0.01) after conversion to Sacubitril/Valsartan. Echocardiographic parameters of left ventricular function and cardiovascular co-medication did not differ markedly between pre- and post-Sacubitril/Valsartan. Conclusion: Sacubitril/Valsartan therapy is associated with an improvement of pulmonary hypertension in HFpEF patients.
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Burgdorf et al. (2021) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension (n=18). Sacubitril/Valsartan vs. Baseline (pre-Sacubitril/Valsartan) was evaluated on Mean pulmonary artery pressure (PAP) in mm Hg (p=<0.05). Transition to Sacubitril/Valsartan significantly reduced median mean pulmonary artery pressure from 33 mm Hg to 27 mm Hg in patients with HFpEF and pulmonary hypertension.
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