Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension
Aims: prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor...
| Autores: | , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universitat Pompeu Fabra |
| Repositorio: | Repositorio Digital de la UPF |
| OAI Identifier: | oai:repositori.upf.edu:10230/54595 |
| Acceso en línea: | http://hdl.handle.net/10230/54595 http://dx.doi.org/10.1002/ehf2.13952 |
| Access Level: | acceso abierto |
| Palabra clave: | ARNI Heart failure Preserved LVEF Pulmonary artery pressure Pulmonary hypertension |
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Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertensionCodina, PauDomingo, MarBarceló, HelenaGastelurrutia, PalomaCasquete,DanielVila, JoanAbdul-Jawad Altisent, OmarSpitaleri, GiosafatCediel, GermanSantiago-Vacas, EvelynZamora, ElisabetRuiz-Cueto, MaríaSantesmases, Javierde la Espriella, RafaelPascual-Figal; Domingo A.Núñez, JulioLupón, JosepBayes-Genis, AntoniARNIHeart failurePreserved LVEFPulmonary artery pressurePulmonary hypertensionAims: prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor Blocker and Neprilysin Inhibitor in HFpEF Patients With CardioMEMS Device (ARNIMEMS-HFpEF) study is to assess pulmonary artery pressure (PAP) dynamics by means of implanted PAP monitors in patients with HFpEF-PH treated with sacubitril/valsartan. Methods and results: this single-arm, investigator-initiated, interventional study included 14 consecutive ambulatory symptomatic HFpEF-PH patients who underwent CardioMEMS implantation prior to enrolment [mean ejection fraction 60.4 ± 7.2%, baseline mean PAP (mPAP) 33.9 ± 7.6 mmHg]. Daily PAP values were examined during three periods: a 6 week period after CardioMEMS implantation and before sacubitril/valsartan treatment (pre-ARNI), a 6 week period with sacubitril/valsartan treatment (ARNI ON), and a 6 week period of sacubitril/valsartan withdrawal (ARNI OFF). The primary endpoint was change in mPAP with and without sacubitril/valsartan. Secondary endpoints included changes in 6 min walking distance, B-line sum in lung ultrasound, and quality of life (QoL). During the study period, 1717 mPAP measurements were recorded. Between pre-ARNI vs. ARNI ON, mPAP significantly declined by -4.99 mmHg [95% confidence interval (CI) -5.55 to -4.43]. Between ARNI ON vs. ARNI OFF, mPAP significantly increased by +2.84 mmHg [95% CI +2.26 to +3.42]. Between pre-ARNI vs. ARNI ON, we found an improvement in 6 min walking distance, B-lines, and QoL. Mean loop diuretic management did not differ between periods. Conclusions: sacubitril/valsartan significantly reduced mPAP in patients with HFpEF-PH, independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and QoL. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH.Wiley202220222022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/54595http://dx.doi.org/10.1002/ehf2.13952reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésCopyright © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/545952026-06-12T07:21:37Z |
| dc.title.none.fl_str_mv |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| title |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| spellingShingle |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension Codina, Pau ARNI Heart failure Preserved LVEF Pulmonary artery pressure Pulmonary hypertension |
| title_short |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| title_full |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| title_fullStr |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| title_full_unstemmed |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| title_sort |
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension |
| dc.creator.none.fl_str_mv |
Codina, Pau Domingo, Mar Barceló, Helena Gastelurrutia, Paloma Casquete,Daniel Vila, Joan Abdul-Jawad Altisent, Omar Spitaleri, Giosafat Cediel, German Santiago-Vacas, Evelyn Zamora, Elisabet Ruiz-Cueto, María Santesmases, Javier de la Espriella, Rafael Pascual-Figal; Domingo A. Núñez, Julio Lupón, Josep Bayes-Genis, Antoni |
| author |
Codina, Pau |
| author_facet |
Codina, Pau Domingo, Mar Barceló, Helena Gastelurrutia, Paloma Casquete,Daniel Vila, Joan Abdul-Jawad Altisent, Omar Spitaleri, Giosafat Cediel, German Santiago-Vacas, Evelyn Zamora, Elisabet Ruiz-Cueto, María Santesmases, Javier de la Espriella, Rafael Pascual-Figal; Domingo A. Núñez, Julio Lupón, Josep Bayes-Genis, Antoni |
| author_role |
author |
| author2 |
Domingo, Mar Barceló, Helena Gastelurrutia, Paloma Casquete,Daniel Vila, Joan Abdul-Jawad Altisent, Omar Spitaleri, Giosafat Cediel, German Santiago-Vacas, Evelyn Zamora, Elisabet Ruiz-Cueto, María Santesmases, Javier de la Espriella, Rafael Pascual-Figal; Domingo A. Núñez, Julio Lupón, Josep Bayes-Genis, Antoni |
| author2_role |
author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
ARNI Heart failure Preserved LVEF Pulmonary artery pressure Pulmonary hypertension |
| topic |
ARNI Heart failure Preserved LVEF Pulmonary artery pressure Pulmonary hypertension |
| description |
Aims: prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor Blocker and Neprilysin Inhibitor in HFpEF Patients With CardioMEMS Device (ARNIMEMS-HFpEF) study is to assess pulmonary artery pressure (PAP) dynamics by means of implanted PAP monitors in patients with HFpEF-PH treated with sacubitril/valsartan. Methods and results: this single-arm, investigator-initiated, interventional study included 14 consecutive ambulatory symptomatic HFpEF-PH patients who underwent CardioMEMS implantation prior to enrolment [mean ejection fraction 60.4 ± 7.2%, baseline mean PAP (mPAP) 33.9 ± 7.6 mmHg]. Daily PAP values were examined during three periods: a 6 week period after CardioMEMS implantation and before sacubitril/valsartan treatment (pre-ARNI), a 6 week period with sacubitril/valsartan treatment (ARNI ON), and a 6 week period of sacubitril/valsartan withdrawal (ARNI OFF). The primary endpoint was change in mPAP with and without sacubitril/valsartan. Secondary endpoints included changes in 6 min walking distance, B-line sum in lung ultrasound, and quality of life (QoL). During the study period, 1717 mPAP measurements were recorded. Between pre-ARNI vs. ARNI ON, mPAP significantly declined by -4.99 mmHg [95% confidence interval (CI) -5.55 to -4.43]. Between ARNI ON vs. ARNI OFF, mPAP significantly increased by +2.84 mmHg [95% CI +2.26 to +3.42]. Between pre-ARNI vs. ARNI ON, we found an improvement in 6 min walking distance, B-lines, and QoL. Mean loop diuretic management did not differ between periods. Conclusions: sacubitril/valsartan significantly reduced mPAP in patients with HFpEF-PH, independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and QoL. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH. |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022 2022 2022 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/10230/54595 http://dx.doi.org/10.1002/ehf2.13952 |
| url |
http://hdl.handle.net/10230/54595 http://dx.doi.org/10.1002/ehf2.13952 |
| dc.language.none.fl_str_mv |
Inglés |
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Inglés |
| dc.rights.none.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
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http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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openAccess |
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application/pdf application/pdf |
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Wiley |
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Wiley |
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reponame:Repositorio Digital de la UPF instname:Universitat Pompeu Fabra |
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Universitat Pompeu Fabra |
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Repositorio Digital de la UPF |
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Repositorio Digital de la UPF |
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