Reduction in pulmonary artery pressures with use of sacubitril/valsartan

Abstract

Pulmonary hypertension due to left heart disease (PH-LHD) frequently complicates heart failure with reduced ejection fraction (HFrEF). Specific therapies for PH have not offered an advantage in patients with PH-LHD. The combined angiotensin receptor blocker-neprilysin inhibitor (ARNI), sacubitril/valsartan, is a novel therapy that can increase levels of natriuretic peptides (NPs). The resulting action on natriuresis and vasodilation may play an important role in the reduction of pulmonary pressures. Here, we report how the use of ARNI in two patients with HFrEF has resulted in an improvement in PH and, consequently, in clinical status and prognosis. <Learning objective: Sacubitril/valsartan (ARNI) is the newest neurohormonal agent approved for therapy in heart failure with reduced ejection fraction (HFrEF). Pulmonary hypertension (PH) due to left heart disease (PH-LHD) is frequent in patients with HFrEF and is associated with a reduced functional class and poor prognosis. The use of ARNI has been associated with a relevant reduction in pulmonary pressures in two cases of PH-LHD.>.

Keywords: Heart failure; Pulmonary artery pressures; Sacubitril/valsartan; Systolic dysfunction.

Fig. 1

The patient presented with high right ventricular-right atrial (RV-RA) peak gradient (A) with elevated estimated right atrial pressure (dilatation of the inferior vena cava) (B); after angiotensin receptor blocker–neprilysin inhibitor was started, a progressive reduction in RV-RA peak gradient was documented at 6 (C) and 12 months (D), respectively.

Fig. 2

This figure shows a “pseudonormal” transmitral flow pattern (A) and elevated right ventricular-right atrial (RV-RA) peak gradient (B) at the first examination of our patient; after treatment with angiotensin receptor blocker–neprilysin inhibitor, there was an improvement in transmitral pattern (C) represented by an impaired relaxation pattern of transmitral flow and a signifcant reduction in RV-RA peak gradient (D).