Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension
Codina, Pau (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Domingo, Mar (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Barceló, Elena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Gastelurrutia, Paloma (Institut d'Investigació Biomèdica de Bellvitge)
Casquete, Daniel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Vila, Joan (Hospital del Mar (Barcelona, Catalunya))
Abdul-Jawad Altisent, Omar (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Spitaleri, Giosafat (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cediel, Germán (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Santiago Vacas, Evelyn (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Zamora, Elisabet (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Ruiz-Cueto, María (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Santesmases, Javier (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
De la Espriella, Rafael (Universitat de València)
Pascual-Figal, DA (Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC))
Núñez, Julio (Universitat de València)
Lupón, Josep (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	ARNI ; Heart failure ; Pulmonary artery pressure ; Pulmonary hypertension ; Preserved LVEF
Publicat a:	ESC Heart Failure, Vol. 9 (may 2022) , p. 2170-2180, ISSN 2055-5822

DOI: 10.1002/ehf2.13952
PMID: 35588235

11 p, 1.8 MB

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