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. 2020 Apr;7(2):757-762.
doi: 10.1002/ehf2.12610. Epub 2020 Feb 19.

Sacubitril/valsartan in patients listed for heart transplantation: effect on physical frailty

Francesco Cacciatore  1   2 , Cristiano Amarelli  2 , Ciro Maiello  2 , Irene Mattucci  2 , Gemma Salerno  2 , Marco Di Maio  3 , Vittorio Palmieri  2 , Francesco Curcio  1 , Flora Pirozzi  1 , Valentina Mercurio  1 , Giuditta Benincasa  4 , Paolo Golino  3 , Domenico Bonaduce  1 , Claudio Napoli  4 , Pasquale Abete  1
Affiliations

Sacubitril/valsartan in patients listed for heart transplantation: effect on physical frailty

Francesco Cacciatore et al. ESC Heart Fail. 2020 Apr.

Abstract

Aims: The aim of this study was to investigate prospectively the effect of sacubitril/valsartan in advanced heart failure (HF) patients in waiting list for heart transplantation (HT) and the effect on physical frailty (PF).

Methods and results: We treated 37 consecutive patients with advanced HF with sacubitril/valsartan. Patients were followed up until HT, device implant, or last follow-up visit after 2 years of follow-up. At baseline, mean New York Heart Association (NYHA) class was 3.1 ± 0.4, with 64.9% in NYHA III and 35.1% NYHA IIIB. Left ventricular ejection fraction was 23.5 ± 5.8%, VO2 max was 10.3 ± 2.3 mL/kg/min, cardiac index was 2.3 ± 0.5 L/min/m2 , and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) was 4943.0 ± 5326.8 pg/mL. After a mean follow-up of 17.1 ± 4.4 months, no deaths were observed, but NYHA class improved significantly with 56.8% in NYHA II, 40.5% in NYHA III, and 2.7% in NYHA IIIB (P < 0.001). VO2 max and 6 min walk test (6MWT) increased, whereas pulmonary systolic blood pressure, E/E', VE/VCO2 slope, and NT-pro-BNP decreased. At right heart catheterization performed after 1 year of follow-up, cardiac index and pulmonary vascular resistance remained stable, while a decrease in systolic pulmonary artery pressure and pulmonary capillary wedge pressure is observed. Furosemide dosage decrease from 102.7 ± 69.4 to 78.7 ± 66.3 mg (P = 0.040). PF decreased from 3.35 ± 1.0 at baseline to 1.57 ± 1.3 at the end of follow-up (P < 0.001), with a reduction in all PF domains.

Conclusions: Our study showed a rapid improvement in PF in HT waiting list patients treated with sacubitril/valsartan. The improvement in all PF domains was paralleled by VO2 and 6MWT increase and together with an NT-pro-BNP reduction constant over the follow-up.

Keywords: Frailty; Heart Failure; Sacubitril/Valsartan.

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Conflict of interest statement

None of the authors have a conflict of interest in the connection with the present study (which includes honorary fee, consultancy, or other profits from the industries producing the drug).

Figures

Figure 1
Figure 1
Mean scores for N‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP) (A), pulmonary blood pressure (mmHg) [systolic pulmonary artery pressure (PAPs)] (B), 6 min walk test (6MWT) (C), and physical frailty (PF) (D), in each time point (baseline, 1 month, 6 months, 12 months, and end of follow‐up). Post‐hoc tests revealed that sacubitril/valsartan elicited a considerable reduction in NT‐pro‐BNP concentration, PAPs, 6MWT, and PF from pretreatment to the end of follow‐up (*P < 0.01).
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