New Therapeutic Regimen in Heart Failure: A Post-marketing Study employing Speckle Tracking Echocardiography

Abraham A K

Abstract


Background

There is robust evidence on mortality benefit after initiation of sacubitril/valsartan in patients with HFrEF;however, the effect on LV function is unknown or is yet to be reported. To our knowledge, this is the first study to report the effect of sacubitril/valsartan on LV function assessed by using 2D speckle strain echocardiography.

Method

We assessed LV function in 27 patients with HFrEF before and after initiation of sacubitril/valsartan to their maximum tolerated dose. Myocardial strain was assessed using a 2-dimensional speckle-tracking software. Among these patients, changes in ejection fraction, mitral annular velocity (MAV) were also measured.

Results

Treatment with sacubitril/valsartan improved the Longitudinal Strain (LS) score (mean = -11.929, SD + 2.875) relative to pre-treatment (mean = -10.270, SD + 2.677) (t26 = 2.895, p = 0.008). On the other hand, treatment with sacubitril/valsartan did not lead to a statistically significant change in MAV and  EF. The mean MAV value of 3.96 (pre-treatment) was close to 3.98 (post-treatment)(Z = -0.443, p = 0.658). Similarly, mean EF was 34.07% and 39.86% (Z = -1.411, p = 0.158) for pre-treatment and post-treatment respectively.

Conclusion

After a 4-week treatment with sacubitril/valsartan, there was a statistically significant change in longitudinal strain which may be an early sign of improvement in LV function in patients with HFrEF. The echocardiographic evaluation had shown an improvement in MAV and EF, though not statistically significant.  Our findings in this study clearly show that sacubitril/valsartan has a direct effect on LV leading to improvement in LV function and thereby reduced mortality and morbidity in patients with HFrEF.  


Full Text:

HTML

References


Roger VL. Epidemiology of Heart Failure. Circ Res. 2013:113:646-659

____________________________________________________________

Hunt SA. American College of Cardiology; American heart Association Task Force on Practice Guidelines. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. J Am Coll Cardiol. 2005:46:e1- e82

____________________________________________________________

Jessup M, Abraham WT. Casey DE. Feldman AM. Francis GS, Ganiats TG, et al, 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119(14):1977-2016.

____________________________________________________________

Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol. 2003; 42:736–742

____________________________________________________________

Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S, et al. Candesartan in Heart Failure Reduction in Mortality (CHARM) Investigators. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation. 2005; 112:3738–3744.

____________________________________________________________

Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation. 2005; 111(25):3411-3419.

____________________________________________________________

Lewis EF, Moye LA, Rouleau JL, Sacks FM, Arnold JM, Warnica JW, et al.; CARE Study. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol. 2003;42(8):1446-1453.

____________________________________________________________

Drugs for chronic heart failure. Medi Lett Drugs Ther 2015: 57:9.

____________________________________________________________

King JB, Shah RU, Bress AP, Nelson RE, Bellows BK. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol Heart Fail. 2016; 4(5):392-402.

____________________________________________________________

McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al.; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014; 371:993–1004.

____________________________________________________________

Yang H, Negishi K, Wang Y, Nolan M, Saito M, Marwick TH. Echocardiographic screening for non-ischaemic stage B heart failure in the community. Eur J Heart Fail. 2016; 18(11):1331-1339.

____________________________________________________________

Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, Sengeløv M, Jørgensen PG, Mogelvang R, Shah AM, Jensen JS. Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017; 10(3). pii: e005521

____________________________________________________________

Schiller NB. Ejection fraction by echocardiography: the full monty or just a peep show? Am Heart J. 2003; 146(3):380–382.

____________________________________________________________

Romano S, Mansour IN, Kansal M, Gheith H, Dowdy Z, Dickens CA, et al. Left Ventricular longitudinal strain predicts heart failure readmission in acute decompensated heart failure. Cardiovasc Ultrasound. 2017; 15: 6.

____________________________________________________________

Nahum J, Bensaid A, Dussault C, Macron L, Clemence D, Bouhemad B, et al. Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients. CircCardiovasc Imaging. 2010; 3(3):249–256.


Refbacks

  • There are currently no refbacks.