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Acute pulmonary pressure change after transition to sacubitril/valsartan in patients with heart failure reduced ejection fraction. | LitMetric

AI Article Synopsis

  • The study investigates the impact of transitioning from ACE inhibitors or ARBs to sacubitril/valsartan on pulmonary artery pressure (PAP) in patients with heart failure.
  • In a cohort of 18 heart failure patients, significant reductions in mean, systolic, and diastolic PAP were observed after switching medications.
  • The decrease in PAP occurred regardless of the patients' initial trans-pulmonary gradient levels, indicating that sacubitril/valsartan may provide consistent benefits in managing pulmonary pressure.

Article Abstract

Aims: Sacubitril/valsartan combines renin-angiotensin-aldosterone system inhibition with amplification of natriuretic peptides. In addition to well-described effects, natriuretic peptides exert direct effects on pulmonary vasculature. The effect of sacubitril/valsartan on pulmonary artery pressure (PAP) has not been fully defined.

Methods And Results: This was a retrospective case-series of PAP changes following transition from angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) to sacubitril/valsartan in patients with heart failure reduced ejection fraction and a previously implanted CardioMEMS™ sensor. Pre-sacubitril/valsartan and post-sacubitril/valsartan PAPs were compared for each patient by examining averaged consecutive daily pressure readings from 1 to 5 days before and after sacubitril/valsartan exposure. PAP changes were also compared between patients based on elevated trans-pulmonary gradients (trans-pulmonary gradient ≥ 12 mmHg) at time of CardioMEMS™ sensor implantation. The cohort included 18 patients, 72% male, mean age 60.1 ± 13.6 years. There was a significant decrease in PAPs associated with transition from ACEI/ARB to sacubitril/valsartan. The median (interquartile range) pre-treatment and post-treatment change in mean, systolic and diastolic PAPs were -3.6 (-9.8, -0.7) mmHg (P < 0.001), -6.5 (-15.0, -2.0) mmHg (P = 0.001), and -2.5 (-5.7, -0.7) (P = 0.001), respectively. The decrease in PAPs was independent of trans-pulmonary gradient (F(1,16) = 0.49, P = 0.49).

Conclusions: In this retrospective case series, transition from ACEI/ARB to sacubitril/valsartan was associated with an early and significant decrease in PAPs.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006690PMC
http://dx.doi.org/10.1002/ehf2.13225DOI Listing

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