Sacubitril/Valsartan vs. Standard Medical Therapy on Exercise Capacity in HFrEF Patients

Abstract

Sacubitril/valsartan (Sac/Val) reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril. However, its effects on functional capacity remain uncertain; consequently, we sought to compare Sac/Val vs. standard medical therapy, in terms of effects on prognostically significant CPET parameters, in HFrEF patients during a long follow-up period. We conducted a single-center, observational study in an HF clinic; specifically, we retrospectively identified that 12 patients switched to Sac/Val and 13 patients that managed with standard, optimal medical therapy (control group). At each visit, baseline, and follow-up (median time: 16 months; IQ range: 11.5-22), we collected demographic information, medical history, vital signs, cardiopulmonary exercise testing, standard laboratory data, pharmacological treatment information, and echocardiographic parameters. The study's primary end-point was the change from baseline in peak VO₂ (adjusted to body weight). We did not observe significant differences between the two study groups at baseline. Similarly, we did not observe any significant differences during the follow-up in mean values of peak VO₂ corrected for body weight: Sac/Val baseline: 12.2 ± 4.6 and FU: 12.7 ± 3.3 vs. control group: 13.1 ± 4.2 and 13.0 ± 4.2 mL/kg/min; p = 0.49. No significant treatment differences were observed for changes in VE/VCO₂ slope: Sac/Val baseline: 35.4 ± 7.4 and FU: 37.2 ± 13.1 vs. control group: 34.6 ± 9.1 and 34.0 ± 7.3; p = 0.49. In conclusion, after a median follow-up period of 16 months, there was no significant benefit of Sac/Val on peak VO₂ and other measures of CPET compared with standard optimal therapy in patients with HFrEF.

Keywords: CPET; HFrEF; exercise capacity; heart failure; peak VO2; sacubitril/valsartan.

Figure 1

Changes of peak VO₂, from baseline to follow-up, in the control group (blue) and the Sac/Val group (yellow) (p 0.49). VO₂: oxygen consumption.

Figure 2

Figure 2. (A) Changes of VE/VCO₂ slope, from baseline to follow-up, in the control group (blue) and in the Sac/Val group (yellow) (p 0.49). (B) Changes of predicted peak VO₂ from baseline to follow-up in the control group (blue) and in the Sac/Val group (yellow) (p 0.53). VE/VCO₂: minute ventilation to carbon dioxide production; VO₂: oxygen consumption.