Key result
Sacubitril/valsartan is associated with a ~26-ms QTc interval reduction at 6 months.
Why the study?
Sacubitril/Valsartan reduced sudden cardiac death in the PARADIGM-HF trial, but the mechanism by which it reduces ventricular arrhythmias remains unclear.
Does sacubitril/valsartan therapy reduce electrocardiographic repolarization/depolarization intervals (QTc, QRS) and echocardiographic left ventricular mechanical dispersion at 6 months in patients with chronic HFrEF on optimal standard of care therapy?
Cohort (n=42)
All the ECG measurements were performed manually by a cardiologist blinded to the patient data
No
Does sacubitril/valsartan therapy reduce electrocardiographic repolarization/depolarization intervals (QTc, QRS) and echocardiographic left ventricular mechanical dispersion at 6 months in patients with chronic HFrEF on optimal standard of care therapy?
Answers are grounded in this paper and cite their sources.
Sacubitril/valsartan is associated with favorable electrical and mechanical reverse remodeling—specifically reductions in QTc interval, QRS duration, and LV mechanical dispersion—offering mechanistic insight into its ability to reduce sudden cardiac death in HFrEF.
Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial. However, the mechanism by which LCZ696 reduces ventricular arrhythmias remains unclear. The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy. We prospectively evaluated chronic Heart Failure (HF) patients with LV ejection fraction ≤40%, despite optimal medical and device therapy, in which LCZ696 therapy was started, while no additional HF treatment was expected to change. ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 and at six months of therapy. A semiautomated analysis of LV GLS was performed and mechanical dispersion index was defined as the standard deviation from 16 time intervals corresponding to each LV segment. Of the 42 patients, 35 completed the six month follow-up, since two patients died and five discontinued treatment for adverse events. QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033) and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months. LCZ696 therapy is associated with a reduction in QTc interval, QRS duration and mechanical dispersion index as assessed by LV GLS.
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Gonçalves et al. (2019) conducted a cohort in Chronic heart failure with reduced ejection fraction (LVEF <=40%) (n=42). Sacubitril/valsartan (LCZ696) vs. Baseline values prior to sacubitril/valsartan initiation (within-patient pre-post comparison on optimal medical and device therapy) was evaluated on Electrocardiographic parameters (QTc interval and QRS duration) and echocardiographic LV mechanical dispersion index at 6 months (p=<0.001). Sacubitril/valsartan significantly reduced QTc interval (451.9 vs. 426.0 ms, p<0.001), QRS duration (125.1 vs. 120.8 ms, p=0.033), and mechanical dispersion (88.4 vs. 78.1 ms, p=0.036) at 6 months.
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