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. 2019 Feb 20;8(2):262.
doi: 10.3390/jcm8020262.

Early Effects of Sacubitril/Valsartan on Exercise Tolerance in Patients with Heart Failure with Reduced Ejection Fraction

Giuseppe Vitale  1 , Giuseppe Romano  2 , Antonino Di Franco  3 , Giuseppa Caccamo  4 , Cinzia Nugara  5   6 , Laura Ajello  7 , Salvo Storniolo  8 , Silvia Sarullo  9 , Valentina Agnese  10 , Francesco Giallauria  11 , Giuseppina Novo  12 , Francesco Clemenza  13 , Filippo M Sarullo  14
Affiliations

Early Effects of Sacubitril/Valsartan on Exercise Tolerance in Patients with Heart Failure with Reduced Ejection Fraction

Giuseppe Vitale et al. J Clin Med. .

Abstract

Background: Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF.

Methods: We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy.

Results: At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3⁻14.9 months) systolic blood pressure decreased from 117 ± 14 to 101 ± 12 mmHg (p < 0.0001), left ventricular ejection fraction (LVEF) increased from 27 ± 6 to 29.7 ± 7% (p < 0.0001), peak oxygen consumption (VO₂) improved from 14.6 ± 3.3 (% of predicted = 53.8 ± 14.1) to 17.2 ± 4.7 mL/kg/min (% of predicted = 64.7 ± 17.8) (p < 0.0001), minute ventilation/carbon dioxide production relationship (VE/VCO₂ Slope) decreased from 34.1 ± 6.3 to 31.7 ± 6.1 (p = 0.006), VO₂ at anaerobic threshold increased from 11.3 ± 2.6 to 12.6 ± 3.5 mL/kg/min (p = 0.007), oxygen pulse increased from 11.5 ± 3.0 to 13.4 ± 4.3 mL/kg/min (p < 0.0001), and ∆VO₂/∆Work increased from 9.2 ± 1.5 to 10.1 ± 1.8 mL/min/watt (p = 0.0002).

Conclusion: Sacubitril/valsartan improved exercise tolerance, LVEF, peak VO₂, and ventilatory efficiency at 6.2 months follow-up. Further studies are necessary to better clarify underlying mechanisms of this functional improvement.

Keywords: cardiopulmonary test; exercise tolerance; heart failure; sacubitril/valsartan.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study design. ARNI: angiotensin receptor-neprilysin inhibitor; CPET: cardiopulmonary exercise test; HFrEF: heart failure with reduced ejection fraction.
Figure 2
Figure 2
Panel A, VE/VCO2 slope variations at follow-up in patients stratified by baseline sacubitril/valsartan dosages; Panel B, peak VO2 variations at follow-up in patients stratified by sacubitril/valsartan dosages.
Figure 3
Figure 3
Panel A, VE/VCO2 slope variations at follow-up in patients stratified by baseline VE/VCO2 slope values. Panel B, Peak VO2 variations at follow-up in patients stratified by baseline VE/VCO2 slope values.
See this image and copyright information in PMC

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