Efficacy and Safety Outcome of Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) in Patients with Heart Failure and Preserved Ejection Fraction (HFpEF): Preliminary Results

Abstract

Fayez Elshaer,1,2 Samih Lawand,3 Mohamed Zeyad,3 Fakhr Al Ayoubi,1 Yassmin Hanfi,3 Abdullah AlQarni1,4 1King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2National Heart Institute, Cairo, Egypt; 3Dallah Hospital, Riyadh, Saudi Arabia; 4Department of Medicine, University of Bisha, Bisha, Saudi ArabiaCorrespondence: Fayez ElshaerKing Fahad Cardiac Center (KFCC), King Khaled University Hospital (KKUH), King Saud University, Riyadh 7805, Saudi ArabiaTel +4671161Fax [phone]Email [email protected]: This study analyzes the safety and efficacy of LCZ696 (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure and preserved ejection fraction (HFpEF).Patients and Methods: An observational pilot study was conducted using a prospective design. A sample of 50 HFpEF patients (27 females and 23 males) was included on LCZ696 (50 mg orally, twice daily), which was then titrated up to a maximum tolerated dose, and followed up in the outpatient clinic. Thirty-seven patients received LCZ696 during hospitalization for decompensated heart failure or before their discharge while same titration was followed for the remaining patients.Results: Patients were classified as New York Heart Association (NYHA) class III (64%), NYHA class IV (22%), and NYHA class II (14%). Diabetes mellitus was found in 74% of patients, while hypertension in 94%. Rapid clinical improvement was found with significant reduction in NYHA class down to NYHA class II (p=0.018). Patients had cleared off the fine basal crackles (specific for the interstitial pulmonary disease) secondary to heart failure (p< 0.001) and improvement or disappearance of edema of the lower limbs (p< 0.001). Heart rate response and jugular venous pressure and NT-pro-BNP were reduced significantly (p-value < 0.001, 0.005, respectively). Echocardiographic criteria for diastolic LV dysfunction (primarily E/A ratio) improved (p=0.001). Serum sodium (NA) levels improved significantly (p=0.015), without worsening renal function or limiting hyperkalemia.Conclusion: LCZ696 (sacubitril/valsartan; ARNI) led to significant clinical improvements in patients with HFpEF. Further, a randomized study is needed to test whether it leads to positive outcomes for a larger sample.Ethical Approval: Project No. E-17-2414, King Saud University, Kingdom of Saudi Arabia.Keywords: impaired diastolic relaxation, left ventricular hypertrophy, LVH, subtle left ventricular systolic dysfunction, ventricular-vascular

Keywords

• impaired diastolic relaxation
• left ventricular hypertrophy (lvh)
• subtle left ventricular systolic dysfunction
• ventricular-vascular