Acute pulmonary pressure change after transition to sacubitril/valsartan in patients with heart failure reduced ejection fraction

ESC Heart Failure

Luanda P. Grazette¹  Jeffrey S. Tran²  Michael W. Fong²  Uri Elkayam²  Hoi Yan Kwong²  Ofer Havakuk²  Jennifer Hwang²  David Shavelle²  Jennifer M. McLeod³  Michael R. Zile⁴ 

[1] Cardiovascular Division, Miller School of Medicine University of Miami Miami FL USA;Department of Internal Medicine Keck School of Medicine of the University of Southern California (USC) Los Angeles CA USA;Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care Albert Einstein College of Medicine New York NY USA;Division of Cardiology, RHJ Department of Veterans Affairs Medical Center Medical University of South Carolina Charleston SC USA;

关键词: Heart failure;    Pulmonary hypertension;    Remote monitoring;    Heart failure reduced ejection fraction;    Implantable monitors;    Neprilysin;   

DOI  :  10.1002/ehf2.13225

来源: DOAJ

【 摘 要 】

Abstract Aims Sacubitril/valsartan combines renin–angiotensin–aldosterone system inhibition with amplification of natriuretic peptides. In addition to well‐described effects, natriuretic peptides exert direct effects on pulmonary vasculature. The effect of sacubitril/valsartan on pulmonary artery pressure (PAP) has not been fully defined. Methods and results This was a retrospective case‐series of PAP changes following transition from angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) to sacubitril/valsartan in patients with heart failure reduced ejection fraction and a previously implanted CardioMEMS™ sensor. Pre‐sacubitril/valsartan and post‐sacubitril/valsartan PAPs were compared for each patient by examining averaged consecutive daily pressure readings from 1 to 5 days before and after sacubitril/valsartan exposure. PAP changes were also compared between patients based on elevated trans‐pulmonary gradients (trans‐pulmonary gradient ≥ 12 mmHg) at time of CardioMEMS™ sensor implantation. The cohort included 18 patients, 72% male, mean age 60.1 ± 13.6 years. There was a significant decrease in PAPs associated with transition from ACEI/ARB to sacubitril/valsartan. The median (interquartile range) pre‐treatment and post‐treatment change in mean, systolic and diastolic PAPs were −3.6 (−9.8, −0.7) mmHg (P < 0.001), −6.5 (−15.0, −2.0) mmHg (P = 0.001), and −2.5 (−5.7, −0.7) (P = 0.001), respectively. The decrease in PAPs was independent of trans‐pulmonary gradient (F(1,16) = 0.49, P = 0.49). Conclusions In this retrospective case series, transition from ACEI/ARB to sacubitril/valsartan was associated with an early and significant decrease in PAPs.

【 授权许可】

Unknown