MEDICAL SCIENCES
Sacubitril Valsartan in HFrEF
An observational series in ambulatory patients with HFrEF Sacubitril valsartan combines renin-angiotensinaldosterone system (RAAS) inhibition with amplification of natriuretic peptides. In addition to well-described effects, on increased natriuresis and diuresis, natriuretic peptides can also exert direct effects on pulmonary vasculature. The effect of sacubitril valsartan on pulmonary artery pressure in patients with heart failure has not been fully defined. This was a retrospective case-series of pulmonary artery pressure 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 (HFrEF) and a previously implanted cardioMEMs pulmonary pressure monitoring sensor. Luanda P Grazette, Cardiovascular Division, Miller School of Medicine, University of Miami Jeffrey S Tran, Department of Internal Medicine, Keck School of Medicine of the University of Southern California (USC) Ofer Havakuk, Head of Heart Failure Service, Tel Aviv Medical Center
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n this retrospective case series, transition from angiotensin converting enzyme inhibitor or angiotensin receptor blocker to sacubitril-valsartan was associated with an early and significant decrease in pulmonary artery pressure.
Introduction
Pulmonary Hypertension (PH) is a common comorbidity in heart failure, which may be present in over half of patients with heart failure with reduced ejection fraction. Although PH is
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A SI A N H O S P I T A L & H EA LT HCA R E M A N AGE M E N T
associated with a considerably worse prognosis with increase morbidity as well as increased mortality, there have been no successful therapies that directly address pulmonary artery hypertension and unequivocally improve clinical outcomes in patients with heart failure. Sacubitril valsartan combines renin angiotensin aldosterone system (RAAS) antagonism with amplification of the natriuretic peptide system conferring beneficial compensatory effects in heart failure. Well-defined effects through increased levels of natriuretic peptides,
IS S UE - 52, 2021
include sustained natriuresis, diuresis and improved myocardial structure and function. Natriuretic peptides, which are increased by sacubitril valsartan, are also expressed in the pulmonary vasculature, where they mediate multiple effects, including vasorelaxation and reverse remodelling. In an exploration of possible clinical consequences of sacubitril/ valsartan on pulmonary vascular pressure in “real world” ambulatory patients with heart failure pulmonary artery pressures were compiled, before and after the transition to sacubitril valsartan, in a
