Cardiology Xagena

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Heart failure with reduced ejection fraction: ejection fraction improvement and reverse remodeling with combination of Sacubitril and Valsartan

Sacubitril / Valsartan ( Entresto ) has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction ( HFrEF ).
The effect of combination of Sacubitril and Valsartan on ejection fraction ( EF ) and reverse remodeling parameters have not been previously described.

Researchers have performed a single-center, retrospective, cohort study of HFrEF patients ( n=48 ) who were treated with Sacubitril / Valsartan for a median duration of 3 months ( interquartile range 2-6 months ).

Sacubitril/Valsartan use was associated with an average 5% ( ±1.2 ) increase in ejection fraction, from a mean baseline of 25.33% to 30.14% ( p less than 0.001 ) with a median duration of treatment 3 months.

There was no significant change in mean LVEF over a median duration of 11 months ( IQR 5.5-15.5 ) between pre-baseline and baseline time points prior to treatment ( p=1.0 ).

The mean increase in ejection fraction tended to be marginally greater in the medium / high dose cohort as compared to the low dose cohort, with a mean increase of 5.09% ( ±1.36 ) and 4.03% ( ±3.17 ), respectively ( p=0.184 ).

There was a 3.36 mm reduction in left ventricular end-systolic diameter ( p=0.04 ), a 2.64 mm reduction in left ventricular end-diastolic diameter ( p=0.02 ), and a 14.4 g/m2 reduction in left ventricular mass index ( p less than 0.01 ).

In conclusion, Sacubitril / Valsartan was found to improve ejection fraction and multiple measures of reverse remodeling beyond the effects of concomitant optimal medical therapy.
Though these results are encouraging, small sample, observational study requires confirmation in larger cohorts with longer follow-up periods. ( Xagena )

Almufleh A et al, Am J Cardiovasc Dis 2017; 7: 108-113