Acute pulmonary pressure change after transition to sacubitril/valsartan in patients with heart failure reduced ejection fraction. (31st January 2021)

• Record Type: Journal Article
• Authors: Tran, Jeffrey S.; Havakuk, Ofer; McLeod, Jennifer M.; Hwang, Jennifer; Kwong, Hoi Yan; Shavelle, David; Zile, Michael R.; Elkayam, Uri; Fong, Michael W.; Grazette, Luanda P.
• Is Part Of: ESC heart failure. Volume 8:Number 2(2021)
• Page Start: 1706
• Page End: 1710
• Publication Date: 2021-01-31
• Subjects: Heart failure -- Pulmonary hypertension -- Remote monitoring -- Heart failure reduced ejection fraction -- Implantable monitors -- Neprilysin; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.13225
• Languages: English
• ISSNs: 2055-5822

Abstract

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.