Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/15733
Title
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension.
Author(s)
Codina, Pau | Domingo, Mar | Barceló, Elena | Gastelurrutia, Paloma | Casquete, Daniel | Vila, Joan | Abdul-Jawad Altisent, Omar | Spitaleri, Giosafat | Cediel, Germán | Santiago-Vacas, Evelyn | Zamora, Elisabet | Ruiz-Cueto, María | Santesmases, Javier | de la Espriella, Rafael | Pascual-Figal, Domingo A CNIC | Nuñez, Julio | Lupón, Josep | Bayes-Genis, Antoni
Date issued
2022-08
Citation
ESC Heart Fail. 2022 Aug;9(4):2170-2180
Language
Inglés
Document type
journal article
Abstract
Prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor Blocker and Neprilysin Inhibitor in HFpEF Patients With CardioMEMS Device (ARNIMEMS-HFpEF) study is to assess pulmonary artery pressure (PAP) dynamics by means of implanted PAP monitors in patients with HFpEF-PH treated with sacubitril/valsartan.
This single-arm, investigator-initiated, interventional study included 14 consecutive ambulatory symptomatic HFpEF-PH patients who underwent CardioMEMS implantation prior to enrolment [mean ejection fraction 60.4 ± 7.2%, baseline mean PAP (mPAP) 33.9 ± 7.6 mmHg]. Daily PAP values were examined during three periods: a 6 week period after CardioMEMS implantation and before sacubitril/valsartan treatment (pre-ARNI), a 6 week period with sacubitril/valsartan treatment (ARNI ON), and a 6 week period of sacubitril/valsartan withdrawal (ARNI OFF). The primary endpoint was change in mPAP with and without sacubitril/valsartan. Secondary endpoints included changes in 6 min walking distance, B-line sum in lung ultrasound, and quality of life (QoL). During the study period, 1717 mPAP measurements were recorded. Between pre-ARNI vs. ARNI ON, mPAP significantly declined by -4.99 mmHg [95% confidence interval (CI) -5.55 to -4.43]. Between ARNI ON vs. ARNI OFF, mPAP significantly increased by +2.84 mmHg [95% CI +2.26 to +3.42]. Between pre-ARNI vs. ARNI ON, we found an improvement in 6 min walking distance, B-lines, and QoL. Mean loop diuretic management did not differ between periods.
Sacubitril/valsartan significantly reduced mPAP in patients with HFpEF-PH, independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and QoL. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH.
MESH
Heart Failure | Hypertension, Pulmonary | Aminobutyrates | Arterial Pressure | Biphenyl Compounds | Humans | Neprilysin | Quality of Life | Sodium Potassium Chloride Symporter Inhibitors | Stroke Volume | Tetrazoles | Valsartan
Online version
DOI
Collections