Sacubitril–valsartan treatment is associated with decrease in central apneas in patients with heart failure with reduced ejection fraction. (1st May 2021)

• Record Type: Journal Article
• Authors: Passino, Claudio; Sciarrone, Paolo; Vergaro, Giuseppe; Borrelli, Chiara; Spiesshoefer, Jens; Gentile, Francesco; Emdin, Michele; Giannoni, Alberto
• Is Part Of: International journal of cardiology. Volume 330(2021)
• Page Start: 112
• Page End: 119
• Publication Date: 2021-05-01
• Subjects: Heart failure -- Central apneas -- Obstructive apneas -- Sacubitril-valsartan; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.02.012
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: To assess the impact of sacubitril-valsartan on apneic burden in patients with heart failure with reduced ejection fraction (HFrEF), 51 stable HFrEF patients planned for switching from an ACE-i/ARB to sacubitril-valsartan were prospectively enrolled. Methods and results: At baseline and after 6 months of treatment, all patients underwent echocardiography, 24-h cardiorespiratory monitoring, neurohormonal evaluation, and cardiopulmonary exercise testing. At baseline 29% and 65% of patients presented with obstructive and central apneas, respectively. After 6 months, sacubitril-valsartan was associated with a decrease in NT-proBNP, improvement in LV function, functional capacity and ventilatory efficiency. After treatment, the apnea-hypopnea index (AHI) decreased across the 24-h period ( p < 0.001), as well as at daytime (p < 0.001) and at nighttime ( p = 0.026), proportionally to baseline severity. When subgrouping according to the type of apneas, daytime, nighttime and 24-h AHI decreased in patients with central apneas (all p < 0.01). Conversely, in patients with obstructive apneas, the effect of drug administration was neutral at nighttime, with significant decrease only in daytime events ( p = 0.007), mainly driven by reduction in hypopneas. Conclusions: Sacubitril-valsartan on top of medical treatment is associated with a reduction in the apneic burden among a real-life cohort of HFrEF patients. The most marked reduction was observed for central apneas. Highlights: Sacubitril-valsartan is associated with a reduction in the apneic burden in heart failure on top of medical treatment. The most evident reduction was observed for central apneas. Central apneas were reduced both at daytime and nighttime. Obstructive apneas and mainly hypopneas were only reduced at daytime.