Key result
Sacubitril/valsartan linked to a ~7 mmHg drop in systolic pulmonary artery pressure in advanced heart failure.
Why the study?
Sacubitril/valsartan is effective in heart failure, but limited data are available regarding its effects in patients with advanced disease.
Does sacubitril/valsartan improve pulmonary and filling pressures in patients with advanced heart failure?
Observational (n=44)
No
Does sacubitril/valsartan improve pulmonary and filling pressures in patients with advanced heart failure?
Absolute Event Rate: 25% vs 32%
p-value: p=<0.0001
Sacubitril/valsartan significantly reduces pulmonary and filling pressures in patients with advanced heart failure, potentially improving clinical status and transplant listing trajectory.
May support hemodynamic assessment in advanced HF; hypothesis-generating and requires RCTs before practice change.
AIMS: The angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan, has been shown to be effective in treatment of patients with heart failure (HF), but limited data are available in patients with advanced disease. This retrospective observational study assessed the effects of ARNI treatment in patients with advanced HF. METHODS AND RESULTS: We reviewed medical records of all advanced HF patients evaluated at our centre for unconventional therapies from September 2016 to January 2019. We studied 44 patients who started ARNI therapy and who had a haemodynamic assessment before beginning ARNI and after 6 ± 2 months. The primary endpoint was variation in pulmonary pressures and filling pressures at 6 months after starting ARNI therapy. Mean patient age was 51.6 ± 7.4 years; 84% were male. At 6 ± 2 months after starting ARNI, there was significant reduction of systolic pulmonary artery pressure [32 mmHg, interquartile range (IQR) 27-45 vs. 25 mmHg, IQR 22.3-36.5; P < 0.0001] and mean pulmonary artery pressure (20 mmHg, IQR 15.3-29.8 vs. 17 mmHg, IQR 13-24.8; P = 0.046). Five of 22 patients (23%) were deferred from the heart transplant list because of improvement, whereas four were listed de novo. After 23 ± 9 months, three patients were treated with a left ventricular assist device implantation, whereas six patients underwent heart transplantation (one in emergency conditions for refractory ventricular tachycardia). CONCLUSIONS: Sacubitril/valsartan is effective in reducing filling pressures and pulmonary pressures in patients with advanced HF. The absence of adverse events during follow-up suggests that sacubitril/valsartan is safe and well-tolerated in this cohort of patients.
No takes yet. Share an insight, caveat, or question.
Gentile et al. (2022) conducted an observational in Advanced heart failure (n=44). Sacubitril/valsartan vs. Baseline (pre-treatment) was evaluated on Variation in systolic pulmonary artery pressure at 6 months (p=<0.0001). Sacubitril/valsartan significantly reduced median systolic pulmonary artery pressure from 32 mmHg to 25 mmHg (P<0.0001) at 6 months in patients with advanced heart failure.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: