Early Effects of Sacubitril/Valsartan on Exercise Tolerance in Patients with Heart Failure with Reduced Ejection Fraction.

Autor: Vitale G; Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy. giuseppevit@hotmail.com., Romano G; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS ⁻ ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy. gromano@ismett.edu., Di Franco A; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA. and2052@med.cornell.edu., Caccamo G; Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy. caccamo.giuseppa@libero.it., Nugara C; Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy. cinzianugara@gmail.com.; Biomedical Department of Internal Medicine and Specialities (DIBIMIS), University of Palermo ⁻ IRCSS Bonino Pulejo, 98124 Messina, Italy. cinzianugara@gmail.com., Ajello L; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS ⁻ ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy. lajello1305@libero.it., Storniolo S; Cardiology Unit, University Hospital, Policlinico Paolo Giaccone, 90127 Palermo, Italy. salvo.storniolo@gmail.com., Sarullo S; Cardiology Unit, University Hospital, Policlinico Paolo Giaccone, 90127 Palermo, Italy. silvia.sarullo@libero.it., Agnese V; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS ⁻ ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy. vagnese@ismett.edu., Giallauria F; Department of Translational Medical Sciences, Division of Internal Medicine, Metabolic and Cardiac Rehabilitation Unit, Federico II University, 80138 Naples, Italy. francesco.giallauria@unina.it., Novo G; Cardiology Unit, University Hospital, Policlinico Paolo Giaccone, 90127 Palermo, Italy. giuseppina.novo@unipa.it., Clemenza F; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS ⁻ ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy. fclemenza@ismett.edu., Sarullo FM; Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy. fsarullo@neomedia.it.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2019 Feb 20; Vol. 8 (2). Date of Electronic Publication: 2019 Feb 20.
DOI: 10.3390/jcm8020262
Abstrakt: Background: Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF.
Methods: We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy.
Results: At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3⁻14.9 months) systolic blood pressure decreased from 117 ± 14 to 101 ± 12 mmHg ( p < 0.0001), left ventricular ejection fraction (LVEF) increased from 27 ± 6 to 29.7 ± 7% ( p < 0.0001), peak oxygen consumption (VO₂) improved from 14.6 ± 3.3 (% of predicted = 53.8 ± 14.1) to 17.2 ± 4.7 mL/kg/min (% of predicted = 64.7 ± 17.8) ( p < 0.0001), minute ventilation/carbon dioxide production relationship (VE/VCO₂ Slope) decreased from 34.1 ± 6.3 to 31.7 ± 6.1 ( p = 0.006), VO₂ at anaerobic threshold increased from 11.3 ± 2.6 to 12.6 ± 3.5 mL/kg/min ( p = 0.007), oxygen pulse increased from 11.5 ± 3.0 to 13.4 ± 4.3 mL/kg/min ( p < 0.0001), and ∆VO₂/∆Work increased from 9.2 ± 1.5 to 10.1 ± 1.8 mL/min/watt ( p = 0.0002).
Conclusion: Sacubitril/valsartan improved exercise tolerance, LVEF, peak VO₂, and ventilatory efficiency at 6.2 months follow-up. Further studies are necessary to better clarify underlying mechanisms of this functional improvement.
Databáze: MEDLINE
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