Acute pulmonary pressure change after transition to sacubitril/valsartan in patients with heart failure reduced ejection fraction

Jeffrey S. Tran, Ofer Havakuk, Jennifer M. McLeod, Jennifer Hwang, Hoi Yan Kwong, David Shavelle, Michael R. Zile, Uri Elkayam, Michael W. Fong, Luanda P. Grazette*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Sacubitril/valsartan combines renin–angiotensin–aldosterone system inhibition with amplification of natriuretic peptides. In addition to well-described effects, natriuretic peptides exert direct effects on pulmonary vasculature. The effect of sacubitril/valsartan on pulmonary artery pressure (PAP) has not been fully defined. Methods and results: This was a retrospective case-series of PAP changes following transition from angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) to sacubitril/valsartan in patients with heart failure reduced ejection fraction and a previously implanted CardioMEMS™ sensor. Pre-sacubitril/valsartan and post-sacubitril/valsartan PAPs were compared for each patient by examining averaged consecutive daily pressure readings from 1 to 5 days before and after sacubitril/valsartan exposure. PAP changes were also compared between patients based on elevated trans-pulmonary gradients (trans-pulmonary gradient ≥ 12 mmHg) at time of CardioMEMS™ sensor implantation. The cohort included 18 patients, 72% male, mean age 60.1 ± 13.6 years. There was a significant decrease in PAPs associated with transition from ACEI/ARB to sacubitril/valsartan. The median (interquartile range) pre-treatment and post-treatment change in mean, systolic and diastolic PAPs were −3.6 (−9.8, −0.7) mmHg (P < 0.001), −6.5 (−15.0, −2.0) mmHg (P = 0.001), and −2.5 (−5.7, −0.7) (P = 0.001), respectively. The decrease in PAPs was independent of trans-pulmonary gradient (F(1,16) = 0.49, P = 0.49). Conclusions: In this retrospective case series, transition from ACEI/ARB to sacubitril/valsartan was associated with an early and significant decrease in PAPs.

Original languageEnglish
Pages (from-to)1706-1710
Number of pages5
JournalESC heart failure
Volume8
Issue number2
DOIs
StatePublished - Apr 2021

Keywords

  • Heart failure
  • Heart failure reduced ejection fraction
  • Implantable monitors
  • Neprilysin
  • Pulmonary hypertension
  • Remote monitoring

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