Clinical and echocardiographic benefit of Sacubitril/Valsartan in a real-world population with HF with reduced ejection fraction

Abstract

The aim of this study was to evaluate the effects of Sacubitril/Valsartan (S/V) on clinical, laboratory and echocardiographic parameters and outcomes in a real-world population with heart failure with reduced ejection fraction (HFrEF). This was a prospective observational study enrolling patients with HFrEF undergoing treatment with S/V. The primary outcome was the composite of cardiac death and HF rehospitalization at 12 months follow-up; secondary outcomes were all-cause death, cardiac death and the occurrence of rehospitalization for worsening HF. The clinical outcome was compared with a retrospective cohort of 90 HFrEF patients treated with standard medical therapy. The study included 90 patients (66.1 ± 11.7 years) treated with S/V. The adjusted regression analysis showed a significantly lower risk for the primary outcome (HR:0.31; 95%CI, 0.11-0.83; p = 0.019) and for HF rehospitalization (HR:0.27; 95%CI, 0.08-0.94; p = 0.039) in S/V patients as compared to the control group. A significant improvement in NYHA class, left ventricular ejection fraction, left ventricular end systolic volume and systolic pulmonary arterial pressure was observed up to 6 months. S/V did not affect negatively renal function and was associated with a significantly lower dose of furosemide dose prescribed at 6- and 12-month follow-up. In this study, S/V reduced the risk of HF rehospitalization and cardiac death at 1 year in patients with HFrEF. S/V improved NYHA class, echocardiographic parameters and need of furosemide, and preserved renal function.

Figure 1

Survival free from worsening HF (panel A), composite outcome (panel B), cardiac death (panel C) and all-cause death (panel D) in the study population. HF, heart failure.

Figure 2

Cumulative incidence of rehospitalization for worsening HF (panel A), composite outcome (panel B), cardiac death (panel C) and all-cause death (panel D) in Sacubitril/Valsartan and standard therapy groups HF, heart failure.

Figure 3

Bar graphs showing the changes of NYHA class from baseline to 6 months in patients treated with Sacubitril/Valsartan.

Figure 4

Box plots showing the changes of echocardiographic parameters form baseline to 6-months follow-up in patients treated with Sacubitril/Valsartan. The boxes represent the interquartile range of the samples and include the median value (horizontal line). The line across the boxes reache the maximum and minimum values. LVEF, left ventricular ejection fraction; LVEDV, left ventricular end diastolic volume; LVESV, left ventricular end systolic volume; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion.

Figure 5

Box plots showing the changes in term of eGFR and furosemide dose regimen from baseline to 6- and 12-months follow-up in patients treated with Sacubitril/Valsartan. eGRF, estimated glomerular filtration rate.