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Title: | Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction | Authors: | MARTENS, Pieter NUYENS, Dieter Rivero-Ayerza, Maximo Van Herendael, Hugo Vercammen, Jan Ceyssens, Wendy Luwel, Evert DUPONT, Matthias MULLENS, Wilfried |
Issue Date: | 2019 | Publisher: | SPRINGER HEIDELBERG | Source: | CLINICAL RESEARCH IN CARDIOLOGY, 108(10), p. 1074-1082 | Abstract: | Background Sacubitril/valsartan reduced the occurrence of sudden cardiac death in the PARADIGM-HF trial. However, limited information is available about the mechanism. Methods Heart failure (HF)-patients receiving sacubitril/valsartan for a class-I indication equipped with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) with remote tele-monitoring were retrospectively analyzed. Device-registered arrhythmic-events were determined [ventricular tachycardia/fibrillation (VT/VF), appropriate therapy, non-sustained VT (NsVT; > 4beats and < 30 s), hourly premature ventricular contraction (PVC)-burden], following sacubitril/valsartan initiation (incident-analysis) and over an equal time period before initiation (antecedent-analysis). Reverse remodeling to sacubitril/valsartan was defined as an improvement of left ventricular ejection fraction of >= 5% between baseline and follow-up. Results A-total of 151 HF-patients with reduced LVEF (29 +/- 9%) were included. Patients were switched from ACE-I or ARB to equal doses of sacubitril/valsartan (expressed as %-target-dose; before = 58 +/- 30% vs. after = 56 +/- 27%). The mean follow-up of both the incident and antecedent analysis was 364 days. Following the initiation, VT/VF-burden dropped (individual patients with VT/VF pre_n = 19 vs. post_n = 10, total-episodes of VT/VF pre_n = 51 vs. post_n = 14, both p < 0.001), resulting in reduced occurrence of appropriate therapy (pre_n = 16 vs. post_n = 6; p < 0.001). NsVT-burden per patient also dropped (mean episodes pre_n = 7.7 +/- 11.8 vs. post_n = 3.7 +/- 5.4; p < 0.001). There was no impact on atrial-fibrillation burden. PVC-burden dropped significantly which was associated with an improvement in BiV-pacing in patients with < 90% BiV-pacing at baseline. A higher degree of reverse remodeling was associated with a lower burden of NsVT and PVCs (both p < 0.05). Conclusion Initiation of sacubitril/valsartan is associated with a lower degree of VT/VF, resulting in less ICD-interventions. This beneficial effect on ventricular arrhythmias might be related to cardiac reverse remodeling. | Notes: | [Martens, Pieter; Nuyens, Dieter; Rivero-Ayerza, Maximo; Van Herendael, Hugo; Vercammen, Jan; Ceyssens, Wendy; Luwel, Evert; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Martens, Pieter] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. | Keywords: | Sacubitril/valsartan; Pharmacology; Heart failure; Ventricular arrhythmias; Reverse remodeling;Sacubitril; valsartan; Pharmacology; Heart failure; Ventricular arrhythmias; Reverse remodeling | Document URI: | http://hdl.handle.net/1942/29861 | ISSN: | 1861-0684 | e-ISSN: | 1861-0692 | DOI: | 10.1007/s00392-019-01440-y | ISI #: | 000487041600002 | Rights: | Springer-Verlag GmbH Germany, part of Springer Nature 2019 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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