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Title: | The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction | Authors: | MARTENS, Pieter BELIEN, Hanne DUPONT, Matthias VANDERVOORT, Pieter MULLENS, Wilfried |
Issue Date: | 2018 | Publisher: | WILEY | Source: | CARDIOVASCULAR THERAPEUTICS, 36(4) | Abstract: | BackgroundMajor classes of medical therapy for heart failure with reduced ejection fraction (HFrEF) induce reverse remodeling. The revere remodeling response to sacubitril/valsartan remains unstudied. MethodsWe performed a single-center, prospective assessor-blinded study to determine the reverse remodeling response of sacubitril/valsartan therapy in HFrEF patients with a class I indication (New York heart Association [NYHA]-class II-IV, Left ventricular ejection fraction [LVEF] < 35%, optimal dose with Renin-Angiotensin-System-Blocker [RAS-blocker]). Doses of sacubitril/valsartan were optimized to individual tolerance. Echocardiographic images were assessed offline by 2 investigators blinded to both the clinical data and timing of echocardiograms. ResultsOne-hundred-twenty-five HFrEF patients (6610years) were prospectively included. The amount of RAS-blocker before and after switch to sacubitril/valsartan was similar(P=.290), indicating individual optimal dosing of sacubitril/valsartan. Over a median(IQR) follow-up of 118(77-160)days after initiation of sacubitril/valsartan, LVEF improved (29.6 +/- 6% vs 34.8 +/- 6%; P<.001) and Left ventricular end-systolic (LVESV) and end-diastolic volume (LVEDV) decreased (LVESV; 147 +/- 57mL vs 129 +/- 55mL; P<.001 and LVEDV; 206 +/- 71mL vs197 +/- 72mL; P=.027). Volumetric remodeling was associated with a reduction in the degree of mitral regurgitation (1.59 +/- 1.0 vs 1.11 +/- 0.8; P<.001; [scale from 0-4]). Metrics of diastolic function improved; including a drop in the E/A-wave ratio (1.75 +/- 1.13 vs 1.38 +/- 0.88; P=.002) and diastolic filling time (% of cycle length) prolonged (48 +/- 9% vs 52 +/- 1%; P=.005). The percent of patients with a restrictive mitral filling pattern dropped from 47% to 23% (P=.004). A dose-dependent effect was noted for changes in LVEF (P<.001) and LVESV (P=.031), with higher doses of sacubitril/valsartan leading to more reverse remodeling. ConclusionSwitching therapy in eligible HFrEF patients from a RAS-blocker to sacubitril/valsartan induces beneficial reverse remodeling of both metrics of systolic as diastolic function. | Notes: | [Martens, Pieter; Belien, Hanne; Dupont, Matthias; Vandervoort, Pieter; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Martens, Pieter] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Vandervoort, Pieter; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. | Keywords: | echocardiography; heart failure; left ventricular ejection fraction; reverse remodeling; sacubitril/valsartan;echocardiography; heart failure; left ventricular ejection fraction; reverse remodeling; sacubitril; valsartan | Document URI: | http://hdl.handle.net/1942/28516 | ISSN: | 1755-5914 | e-ISSN: | 1755-5922 | DOI: | 10.1111/1755-5922.12435 | ISI #: | 000438495800005 | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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