Influence of sacubitril/valsartan on exercise tolerance, left ventricular mass index and diastolic function in patients with HFpEF and left ventricular hypertrophy

Objective. To assess the effect of neprilysin/angiotensin receptor inhibitor (sacubitril/valsartan, S/V) on exercise capacity, left ventricular (LV) mass index and diastolic function, serum NT-proBNP in patients with chronic HFpEF and concentric LV hypertrophy. Material and methods. A prospective single-center trial enrolled 45 patients with chronic HFpEF NYHA class II―III, moderate/severe hypertensive concentric LV hypertrophy (LV mass index ≥132 g/m2 for men or ≥109 g/m2 for women) and increased LV filling pressures at rest and/or during exercise. All participants were randomly assigned in an open-label fashion to receive S/V 50–200 mg daily or to the control group (individualized therapy including ACE inhibitors or ARBs) with a ratio of 2:1 for 6 months. At baseline and after 6 months, all participants underwent echocardiography at rest and during exercise, a 6-minute walk test and laboratory testing. Results. In the S/V group, 6MWD increased by 20 m (95% CI 12—28), quality of life improved (Minnesota Questionnaire) by 5 points (95% CI –8— –2), left ventricular mass index decreased by 17 g/m2 (95% CI –21— –13), indexed left atrial volume decreased by 2.8 ml/m2 (95% CI –9.2— –0.8), E/e′ ratio decreased by 1.8 (95% CI –3.2— –0.02) and serum NT-proBNP decreased by 26% (95% CI –53— –2%; p<0.05) after 6 months compared to the control group. Conclusion. Treatment with S/V was associated with improvement in exercise capacity and reduction of LV hypertrophy and LV filling pressure, improved diastolic reserve and decrease of serum NT-proBNP in patients with HFpEF and advanced LV hypertrophy.