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Fayez Elshaer,1,2 Samih Lawand,3 Mohamed Zeyad,3 Fakhr Al Ayoubi,1 Yassmin Hanfi,3 Abdullah AlQarni1,4 1King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2National Heart Institute, Cairo, Egypt; 3Dallah Hospital, Riyadh, Saudi Arabia; 4Department of Medicine, University of Bisha, Bisha, Saudi ArabiaCorrespondence: Fayez ElshaerKing Fahad Cardiac Center (KFCC), King Khaled University Hospital (KKUH), King Saud University, Riyadh 7805, Saudi ArabiaTel +4671161Fax +4671158Email felshaer@ksu.edu.saPurpose: This study analyzes the safety and efficacy of LCZ696 (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure and preserved ejection fraction (HFpEF).Patients and Methods: An observational pilot study was conducted using a prospective design. A sample of 50 HFpEF patients (27 females and 23 males) was included on LCZ696 (50 mg orally, twice daily), which was then titrated up to a maximum tolerated dose, and followed up in the outpatient clinic. Thirty-seven patients received LCZ696 during hospitalization for decompensated heart failure or before their discharge while same titration was followed for the remaining patients.Results: Patients were classified as New York Heart Association (NYHA) class III (64%), NYHA class IV (22%), and NYHA class II (14%). Diabetes mellitus was found in 74% of patients, while hypertension in 94%. Rapid clinical improvement was found with significant reduction in NYHA class down to NYHA class II (p=0.018). Patients had cleared off the fine basal crackles (specific for the interstitial pulmonary disease) secondary to heart failure (p< 0.001) and improvement or disappearance of edema of the lower limbs (p< 0.001). Heart rate response and jugular venous pressure and NT-pro-BNP were reduced significantly (p-value < 0.001, 0.005, respectively). Echocardiographic criteria for diastolic LV dysfunction (primarily E/A ratio) improved (p=0.001). Serum sodium (NA) levels improved significantly (p=0.015), without worsening renal function or limiting hyperkalemia.Conclusion: LCZ696 (sacubitril/valsartan; ARNI) led to significant clinical improvements in patients with HFpEF. Further, a randomized study is needed to test whether it leads to positive outcomes for a larger sample.Ethical Approval: Project No. E-17-2414, King Saud University, Kingdom of Saudi Arabia.Keywords: impaired diastolic relaxation, left ventricular hypertrophy, LVH, subtle left ventricular systolic dysfunction, ventricular-vascular |
