Myocardial work improvement after sacubitril–valsartan therapy: a new echocardiographic parameter for a new treatment. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Valentim Gonçalves, António; Galrinho, Ana; Pereira-da-Silva, Tiago; Branco, Luísa; Rio, Pedro; Timóteo, Ana T.; Abreu, João; Soares, Rui M.; Feliciano, Joana; Moreira, Rita I.; Ferreira, Rui C.
• Is Part Of: Journal of cardiovascular medicine. Volume 21:Issue 3(2020:Mar.)
• Publication Date: 2020-03
• Subjects: heart failure -- myocardial work -- reverse remodelling -- sacubitril–valsartan -- transthoracic echocardiography; Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000000932
• Languages: English
• ISSNs: 1558-2027

Abstract

Abstract : Aims: Myocardial work is a new transthoracic echocardiogram (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS). Nothing is known about the impact of sacubitril/valsartan (LCZ696) therapy on myocardial work parameters. The aim of this study was to evaluate the effects of LCZ696 on LV myocardial work in heart failure patients. Methods: Prospective evaluation of chronic heart failure patients with LV ejection fraction of 40% or less despite optimized standard of care therapy, in which LCZ696 therapy was started and no other heart failure treatment was expected to change. TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of LV GLS was made and myocardial work estimated using custom software of the GE Vivid E95 ultrasound system. Results: Of the 42 patients, 35 (83.3%) completed the 6 months, follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment due to adverse events. Mean age was 58.6 ± 11.1 years. TTE data showed a significant reduction in LV dimensions and atrial volumes, as well as an improvement in LV ejection fraction (29.3 vs. 35.2%, P = 0.001) and GLS (−7.0 vs. −8.9%, P = 0.001). Myocardial work had a significant increase in global constructive work (720.2 vs. 900.6 mmHg%, P = 0.016) and global work efficiency (78.6 vs. 86.6%, P = 0.027), with a nonsignificant decrease in global wasted work (150.2 vs. 136.8 mmHg%, P = 0.441) at 6 months. Conclusion: LCZ696 therapy was associated with signs of reverse remodelling by usual TTE parameters and LV myocardial work at 6 months, including an increase in global constructive work and work efficiency.