Effects of Sacubitril/Valsartan on the Arterial Stiffness and Left Ventricular-Arterial Coupling in Patients With Heart Failure With Reduced Ejection Fraction

Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC) and arterial stiffness in HFrEF patients. Material and methods. Arterial stiffness by applanation tonometry and LVAC – by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69Ѓ}9 years, 89% male, arterial hypertension – 83%, diabetes – 39%, myocardial infarction – 89%, left ventricular ejection fraction 32Ѓ}4%) initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance)/ Ees (left ventricular elastance) ratio. Differences were considered statistically significant at p<0.05. Results. 72% of patients initially had elevated pulse wave velocity (PWV>10 m/s). The decrease in PWV (from 11.5Ѓ}2.9 to 10.2Ѓ}2.9 m/s, p<0.05), of the augmentation pressure (from 15.3Ѓ}8.9 to 10.5Ѓ}5.0 mm Hg, p=0.002), the increase in the reflected wave transit time (from 132Ѓ}9 to 143Ѓ}29 ms, p=0.02) and the subendocardial viability ratio (from 164Ѓ}25 to 177Ѓ}37%; p=0.009) were found after 12 months. Sacubitryl/valsartanbased therapy was associated with a decrease in central systolic blood pressure (from 116Ѓ}19 to 106Ѓ}10 mm Hg; p=0.001) and central pulse blood pressure (from 44Ѓ}15 to 38Ѓ}7 mm Hg; p<0.05). Decrease in Ea (from 2.20Ѓ}0.84 to 1.79Ѓ}0.63 mm Hg/ml/m2; p=0.005) and Ea/Ees ratio (from 2.26Ѓ}0.77 to 1.68Ѓ}0.32, p=0.05) was found after 12 months. Ees did not change statistically significantly (1.00Ѓ}0.34 vs 1.01Ѓ}0.44 mm Hg/ml/m2). The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found. Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave.