Haemodynamic effects of sacubitril/valsartan in advanced heart failure

ESC Heart Failure

Maria Frigerio¹  Piero Gentile¹  Luciana D'Angelo¹  Enrico Ammirati¹  Marisa Varrenti¹  Rosaria Cantone¹  Andrea Garascia¹  Alessandro Verde¹  Grazia Foti¹  Enrico Perna¹  Gabriella Masciocco¹  Manlio Cipriani¹ 

[1] De Gasperis Cardio Center and Transplant Center Niguarda Hospital Milan Italy;

关键词: Heart failure;    Sacubitril/valsartan;    Heart transplantation;    Pulmonary artery pressures;    Filling pressures;    Real‐life practice;   

DOI  :  10.1002/ehf2.13755

来源: DOAJ

【 摘 要 】

Abstract 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.

【 授权许可】

Unknown