Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension

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 Blocke...

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Autores: Codina, Pau|||0000-0002-2469-5711, Domingo, Mar|||0000-0002-2935-1272, Barceló, Elena, Gastelurrutia, Paloma|||0000-0001-6974-9210, Casquete, Daniel|||0000-0002-1358-2412, Vila, Joan, Abdul-Jawad Altisent, Omar|||0000-0002-8884-0172, Spitaleri, Giosafat|||0000-0002-0214-9082, Cediel, Germán|||0000-0001-9667-7507, Santiago Vacas, Evelyn|||0000-0001-7511-406X, Zamora, Elisabet|||0000-0001-5317-7481, Ruiz-Cueto, María, Santesmases, Javier|||0000-0002-1226-1617, De la Espriella, Rafael|||0000-0002-8720-3999, Pascual-Figal, DA|||0000-0002-4993-9540, Núñez, Julio|||0000-0003-1672-7119, Lupón, Josep|||0000-0002-5601-9611, Bayés-Genís, Antoni|||0000-0002-3044-197X
Tipo de recurso: artículo
Fecha de publicación:2022
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:281835
Acceso en línea:https://ddd.uab.cat/record/281835
https://dx.doi.org/urn:doi:10.1002/ehf2.13952
Access Level:acceso abierto
Palabra clave:ARNI
Heart failure
Pulmonary artery pressure
Pulmonary hypertension
Preserved LVEF
Descripción
Sumario: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. 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. 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.

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