Codina, PauDomingo, MarBarceló, ElenaGastelurrutia, PalomaCasquete, DanielVila, JoanAbdul-Jawad Altisent, OmarSpitaleri, GiosafatCediel, GermánSantiago-Vacas, EvelynZamora, ElisabetRuiz-Cueto, MaríaSantesmases, Javierde la Espriella, RafaelPascual-Figal, Domingo ANuñez, JulioLupón, JosepBayes-Genis, Antoni2023-04-032023-04-032022-08ESC Heart Fail. 2022 Aug;9(4):2170-2180http://hdl.handle.net/20.500.12105/15733Prior 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.engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/Heart FailureHypertension, PulmonaryAminobutyratesArterial PressureBiphenyl CompoundsHumansNeprilysinQuality of LifeSodium Potassium Chloride Symporter InhibitorsStroke VolumeTetrazolesValsartanAttribution-NonCommercial-NoDerivatives 4.0 Internacional3558823594217010.1002/ehf2.139522055-5822ESC heart failureopen access