Journal of Clinical Medicine (Jun 2020)

Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction

  • Francesco Giallauria,
  • Giuseppe Vitale,
  • Mario Pacileo,
  • Anna Di Lorenzo,
  • Alessandro Oliviero,
  • Francesco Passaro,
  • Roberta Calce,
  • Alessandro Parlato,
  • Crescenzo Testa,
  • Giuseppe D’Ambrosio,
  • Giuseppe Romano,
  • Francesco Clemenza,
  • Silvia Sarullo,
  • Elio Venturini,
  • Marco Gentile,
  • Cinzia Nugara,
  • Gabriella Iannuzzo,
  • Antonello D’Andrea,
  • Carlo Vigorito,
  • Filippo M. Sarullo

DOI
https://doi.org/10.3390/jcm9061897
Journal volume & issue
Vol. 9, no. 6
p. 1897

Abstract

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Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. Methods: Patients with HFrEF admitted to outpatients’ services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. Results: Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p 2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p 2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = −0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = −0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = −0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p p < 0.001). Conclusions: In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.

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