Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension

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• dc.contributor.author Codina, Pau
• dc.contributor.author Domingo, Mar
• dc.contributor.author Barceló, Helena
• dc.contributor.author Gastelurrutia, Paloma
• dc.contributor.author Casquete,Daniel
• dc.contributor.author Vila, Joan
• dc.contributor.author Abdul-Jawad Altisent, Omar
• dc.contributor.author Spitaleri, Giosafat
• dc.contributor.author Cediel, German
• dc.contributor.author Santiago-Vacas, Evelyn
• dc.contributor.author Zamora, Elisabet
• dc.contributor.author Ruiz-Cueto, María
• dc.contributor.author Santesmases, Javier
• dc.contributor.author de la Espriella, Rafael
• dc.contributor.author Pascual-Figal; Domingo A.
• dc.contributor.author Núñez, Julio
• dc.contributor.author Lupón, Josep
• dc.contributor.author Bayes-Genis, Antoni
• dc.date.accessioned 2022-10-26T07:09:30Z
• dc.date.available 2022-10-26T07:09:30Z
• dc.date.issued 2022
• dc.description.abstract Aims: prior studies have not fully characterized the haemodynamic effects of the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan in heart failure with preserved ejection fraction and pulmonary hypertension (HFpEF-PH). The aim of the Treatment of PH With Angiotensin II Receptor Blocker and Neprilysin Inhibitor in HFpEF Patients With CardioMEMS Device (ARNIMEMS-HFpEF) study is to assess pulmonary artery pressure (PAP) dynamics by means of implanted PAP monitors in patients with HFpEF-PH treated with sacubitril/valsartan. Methods and results: this single-arm, investigator-initiated, interventional study included 14 consecutive ambulatory symptomatic HFpEF-PH patients who underwent CardioMEMS implantation prior to enrolment [mean ejection fraction 60.4 ± 7.2%, baseline mean PAP (mPAP) 33.9 ± 7.6 mmHg]. Daily PAP values were examined during three periods: a 6 week period after CardioMEMS implantation and before sacubitril/valsartan treatment (pre-ARNI), a 6 week period with sacubitril/valsartan treatment (ARNI ON), and a 6 week period of sacubitril/valsartan withdrawal (ARNI OFF). The primary endpoint was change in mPAP with and without sacubitril/valsartan. Secondary endpoints included changes in 6 min walking distance, B-line sum in lung ultrasound, and quality of life (QoL). During the study period, 1717 mPAP measurements were recorded. Between pre-ARNI vs. ARNI ON, mPAP significantly declined by -4.99 mmHg [95% confidence interval (CI) -5.55 to -4.43]. Between ARNI ON vs. ARNI OFF, mPAP significantly increased by +2.84 mmHg [95% CI +2.26 to +3.42]. Between pre-ARNI vs. ARNI ON, we found an improvement in 6 min walking distance, B-lines, and QoL. Mean loop diuretic management did not differ between periods. Conclusions: sacubitril/valsartan significantly reduced mPAP in patients with HFpEF-PH, independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and QoL. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH.
• dc.format.mimetype application/pdf
• dc.identifier.citation Codina P, Domingo M, Barceló E, Gastelurrutia P, Casquete D, Vila J, et al. Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension. ESC Heart Fail. 2022 Aug; 9(4): 2170-80. DOI: 10.1002/ehf2.13952
• dc.identifier.doi http://dx.doi.org/10.1002/ehf2.13952
• dc.identifier.issn 2055-5822
• dc.identifier.uri http://hdl.handle.net/10230/54595
• dc.language.iso eng
• dc.publisher Wiley
• dc.rights Copyright © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword ARNI
• dc.subject.keyword Heart failure
• dc.subject.keyword Preserved LVEF
• dc.subject.keyword Pulmonary artery pressure
• dc.subject.keyword Pulmonary hypertension
• dc.title Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion