Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure.

Autor:	Nederend M; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Kiès P; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Regeer MV; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Vliegen HW; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Mertens BJ; Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands., Robbers-Visser D; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands., Bouma BJ; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Amsterdam University Medical Center, Amsterdam, The Netherlands., Tops LF; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Schalij MJ; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Jongbloed MRM; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands.; Anatomy & Embryology, Leiden University Medical Center, Leiden, The Netherlands., Egorova AD; Center for Congenital Heart Disease Amsterdam Leiden (CAHAL), Leiden University Medical Center, Leiden, The Netherlands a.egorova@lumc.nl.; Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk:	angličtina
Zdroj:	Heart (British Cardiac Society) [Heart] 2023 Sep 28; Vol. 109 (20), pp. 1525-1532. Date of Electronic Publication: 2023 Sep 28.
DOI:	10.1136/heartjnl-2022-322332
Abstrakt:	Objective: Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to sRV dysfunction. Pharmacological options for sRV failure remain poorly defined. This study aims to investigate the tolerability and effects of sacubitril/valsartan on sRV failure in adult patients with sRV. Methods: In this two-centre, prospective cohort study, all consecutive adult patients with symptomatic heart failure and at least moderately reduced sRV systolic function were initiated on sacubitril/valsartan and underwent structured follow-up. Results: Data of 40 patients were included (40% female, 30% ccTGA, median age 48 (44-53) years). Five patients discontinued therapy during titration. Median follow-up was 24 (12-36) months. The maximal dose was tolerated by 49% of patients. No episodes of hyperkalaemia or renal function decline occurred. Six-minute walking distance increased significantly after 6 months of treatment (569±16 to 597±16 m, p=0.016). Serum N-terminal-prohormone brain natriuretic peptide (NT-proBNP) levels decreased significantly after 3 months (567 (374-1134) to 404 (226-633) ng/L, p<0.001). Small, yet consistent echocardiographic improvements in sRV function were observed after 6 months (sRV global longitudinal strain: -11.1±0.5% to -12.6±0.7%, p<0.001, and fractional area change: 20% (16%-24%) to 26% (19%-30%), p<0.001). The linear mixed-effects model illustrated that after first follow-up moment, no time effect was present for the parameters. Conclusions: Treatment with sacubitril/valsartan was associated with a low rate of adverse effects in this adult sRV cohort. Persisting improvement in 6-minute walking test distance, NT-proBNP levels and echocardiographic parameters of sRV function was observed in an on-treatment analysis and showed no differential response based on sex or anatomy. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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