Effect of Sacubitril/Valsartan or Enalapril on Left Ventricular Function in Patients With Hematologic Malignancies Treated With Bone Marrow Transplantation

Konstantinos Katogiannis, MD, PhD; Ignatios Ikonomidis, MD, PhD; Dimitrios Farmakis, MD, PhD; John Thymis, MD, PhD; Maria Stamouli, MD, PhD; Georgia Aggeliki Koliou, MSc; George Makavos, MD, PhD; Damianos Tsilivarakis, MD; Dionisios Vythoulkas, PhD; Panagiotis Tsirigotis, MD, PhD

JACC: Advances (Mar 2025)

Effect of Sacubitril/Valsartan or Enalapril on Left Ventricular Function in Patients With Hematologic Malignancies Treated With Bone Marrow Transplantation

Konstantinos Katogiannis, MD, PhD,
Ignatios Ikonomidis, MD, PhD,
Dimitrios Farmakis, MD, PhD,
John Thymis, MD, PhD,
Maria Stamouli, MD, PhD,
Georgia Aggeliki Koliou, MSc,
George Makavos, MD, PhD,
Damianos Tsilivarakis, MD,
Dionisios Vythoulkas, PhD,
Panagiotis Tsirigotis, MD, PhD

Affiliations

Konstantinos Katogiannis, MD, PhD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece; Address for correspondence: Dr Konstantinos Katogiannis, 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari 12462, Greece.
Ignatios Ikonomidis, MD, PhD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece; Prof Ignatios Ikonomidis, 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari 12462, Greece.
Dimitrios Farmakis, MD, PhD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
John Thymis, MD, PhD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
Maria Stamouli, MD, PhD: Unit of Hematology, 2nd Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
Georgia Aggeliki Koliou, MSc: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
George Makavos, MD, PhD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
Damianos Tsilivarakis, MD: 2nd Cardiology Department, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
Dionisios Vythoulkas, PhD: Unit of Hematology, 2nd Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
Panagiotis Tsirigotis, MD, PhD: Unit of Hematology, 2nd Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece

Journal volume & issue: Vol. 4, no. 3
p. 101628

Abstract

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Background: In patients with bone marrow transplantation (BMT) for hematologic malignancies, evidence for prevention of cancer therapy-related cardiac dysfunction (CTRCD) remains limited. Objectives: The authors investigated whether early initiation of sacubitril/valsartan or enalapril could be helpful to prevent CTRCD in patients undergoing BMT. Methods: We randomized 90 patients with preserved left ventricular ejection fraction (LVEF) after BMT to sacubitril/valsartan, enalapril, or no cardioprotective medication (controls). The primary endpoints included i) LVEF, ii) LV global longitudinal strain (GLS), iii) myocardial wasted work (GWW), and work efficiency (GWE) by speckle tracking echocardiography. Secondary endpoints included changes in LV volumes. Results: Patients treated with sacubitril/valsartan or enalapril for 6 months did not show a deterioration of LV GLS or LVEF (P > 0.05). Conversely, controls showed impaired LV GLS (−20.9% ± 2.1% vs −18.8% ± 2.6%, P = 0.001) and reduced LVEF (P = 0.045) at 6 months post-BMT. The percent improvement of GWW and GWE was greater in the sacubitril/valsartan compared to enalapril or control group (P = 0.044 and P = 0.011, respectively) at 6 months. Conversely, in controls, GWW increased (80.7 ± 60.6 vs 115.3 ± 52.1 mm Hg%, P = 0.045), and GWE was compromised (P = 0.030) at 6 months post-BMT. Among the 3 treatment groups, only sacubitril/valsartan group showed a reduction in LV end-diastolic and systolic volume compared to baseline (102.3 ± 26.9 vs 93.2 ± 18.9 mL, P = 0.042 and 44.5 ± 15.4 vs 39.1 ± 10.1 mL, P = 0.012, respectively). Conclusions: Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function at 6 months in patients with hematologic malignancies treated with BMT. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work indices. (Effect of Angiotensin Converting Enzyme and Sacubitril Valsartan in Patients After Bone Marrow Transplantation; NCT04092309)

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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