1
|
Veltmann C, Duncker D, Doering M, Gummadi S, Robertson M, Wittlinger T, Colley BJ, Perings C, Jonsson O, Bauersachs J, Sanchez R, Maier LS. Therapy duration and improvement of ventricular function in de novo heart failure: the Heart Failure Optimization study. Eur Heart J 2024:ehae334. [PMID: 38864173 DOI: 10.1093/eurheartj/ehae334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND AND AIMS In patients with de novo heart failure with reduced ejection fraction (HFrEF), improvement of left ventricular ejection fraction (LVEF) is expected to occur when started on guideline-recommended medical therapy. However, improvement may not be completed within 90 days. METHODS Patients with HFrEF and LVEF ≤ 35% prescribed a wearable cardioverter-defibrillator between 2017 and 2022 from 68 sites were enrolled, starting with a registry phase for 3 months and followed by a study phase up to 1 year. The primary endpoints were LVEF improvement > 35% between Days 90 and 180 following guideline-recommended medical therapy initiation and the percentage of target dose reached at Days 90 and 180. RESULTS A total of 598 patients with de novo HFrEF [59 years (interquartile range 51-68), 27% female] entered the study phase. During the first 180 days, a significant increase in dosage of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was observed (P < .001). At Day 90, 46% [95% confidence interval (CI) 41%-50%] of study phase patients had LVEF improvement > 35%; 46% (95% CI 40%-52%) of those with persistently low LVEF at Day 90 had LVEF improvement > 35% by Day 180, increasing the total rate of improvement > 35% to 68% (95% CI 63%-72%). In 392 patients followed for 360 days, improvement > 35% was observed in 77% (95% CI 72%-81%) of the patients. Until Day 90, sustained ventricular tachyarrhythmias were observed in 24 wearable cardioverter-defibrillator carriers (1.8%). After 90 days, no sustained ventricular tachyarrhythmia occurred in wearable cardioverter-defibrillator carriers. CONCLUSIONS Continuous optimization of guideline-recommended medical therapy for at least 180 days in HFrEF is associated with additional LVEF improvement > 35%, allowing for better decision-making regarding preventive implantable cardioverter-defibrillator therapy.
Collapse
Affiliation(s)
- Christian Veltmann
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Heart Center Bremen, Electrophysiology Bremen, Senator-Wessling-Str. 1, 28277 Bremen, Germany
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Michael Doering
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Siva Gummadi
- Department of Cardiology, CVI of Central Florida, Ocala, FL, USA
| | | | - Thomas Wittlinger
- Department of Cardiology, Asklepios Harzklinik Goslar, Goslar, Germany
| | - Byron J Colley
- Department of Cardiology, Jackson Heart Clinic, Jackson, MS, USA
| | - Christian Perings
- Department of Cardiology, Katholisches Klinikum Luenen, Luenen, Germany
| | - Orvar Jonsson
- Department of Cardiology, Sanford Cardiovascular Institute, Sioux Falls, SD, USA
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Robert Sanchez
- Department of Cardiology, HCA Florida Heart Institute, St. Petersburg, FL, USA
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
2
|
Choi HM, Hwang IC, Choi HJ, Yoon YE, Lee HJ, Park JB, Lee SP, Kim HK, Kim YJ, Cho GY. Irreversible myocardial injury attenuates the benefits of sacubitril/valsartan in heart failure patients. Int J Cardiol 2024; 397:131611. [PMID: 38030041 DOI: 10.1016/j.ijcard.2023.131611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Despite the established benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) across various etiologies, there are controversies regarding the effects of ARNI in patients with irreversible myocardial injury. The aim of this study is to investigate the impact of irreversible myocardial injury on the benefits of ARNI treatment in patients with HFrEF, consisted of both ischemic and non-ischemic etiologies. METHODS AND RESULTS We conducted a retrospective single-center study including 409 consecutive patients with HFrEF treated with ARNI between March 2017 and May 2020. Irreversible myocardial injury was defined as nonviable myocardium without contractile reserve, which suggests a limited potential for recovery of left ventricular function and geometry. At baseline, irreversible myocardial injury was observed in 129 (31.5%) patients. Composite outcome was cardiovascular death or hospitalization for heart failure, which occurred in 56 (43.4%) and 61 (21.8%) patients with and without irreversible myocardial injury, respectively. On multivariable analysis, irreversible injury presence, but not ischemic etiology, was an independent predictor of composite outcome (hazard ratio 2.16, 95% confidence interval 1.33-3.49). Mediation analysis revealed that the increased risk of the composite outcome due to irreversible myocardial injury was mediated by attenuated LV reverse remodeling (Z value = 2.02, P = 0.043). CONCLUSIONS The presence of irreversible myocardial injury was significantly associated with the response to ARNI treatment in patients with HFrEF, regardless of etiology.
Collapse
Affiliation(s)
- Hong-Mi Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hye Jung Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| |
Collapse
|
3
|
Kodsi M, Makarious D, Gan GC, Choudhary P, Thomas L. Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure. ESC Heart Fail 2023; 10:3258-3275. [PMID: 37871982 PMCID: PMC10682888 DOI: 10.1002/ehf2.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023] Open
Abstract
Recently established heart failure therapies, including sodium glucose co-transporter 2 inhibitors, angiotensin-neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non-invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non-invasive end-points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non-invasive cardiac imaging techniques, in particular transthoracic echocardiography.
Collapse
Affiliation(s)
- Matthew Kodsi
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - David Makarious
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Gary C.H. Gan
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - Preeti Choudhary
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Liza Thomas
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
- South West clinical SchoolUniversity of New South WalesSydneyAustralia
| |
Collapse
|
4
|
Wan J, Zhang Z, Wu C, Tian S, Zang Y, Jin G, Sun Q, Wang P, Luan X, Yang Y, Zhan X, Ye LL, Duan DD, Liu X, Zhang W. Astragaloside IV derivative HHQ16 ameliorates infarction-induced hypertrophy and heart failure through degradation of lncRNA4012/9456. Signal Transduct Target Ther 2023; 8:414. [PMID: 37857609 PMCID: PMC10587311 DOI: 10.1038/s41392-023-01660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Reversing ventricular remodeling represents a promising treatment for the post-myocardial infarction (MI) heart failure (HF). Here, we report a novel small molecule HHQ16, an optimized derivative of astragaloside IV, which effectively reversed infarction-induced myocardial remodeling and improved cardiac function by directly acting on the cardiomyocyte to reverse hypertrophy. The effect of HHQ16 was associated with a strong inhibition of a newly discovered Egr2-affiliated transcript lnc9456 in the heart. While minimally expressed in normal mouse heart, lnc9456 was dramatically upregulated in the heart subjected to left anterior descending coronary artery ligation (LADL) and in cardiomyocytes subjected to hypertrophic stimulation. The critical role of lnc9456 in cardiomyocyte hypertrophy was confirmed by specific overexpression and knockout in vitro. A physical interaction between lnc9456 and G3BP2 increased NF-κB nuclear translocation, triggering hypertrophy-related cascades. HHQ16 physically bound to lnc9456 with a high-affinity and induced its degradation. Cardiomyocyte-specific lnc9456 overexpression induced, but knockout prevented LADL-induced, cardiac hypertrophy and dysfunction. HHQ16 reversed the effect of lnc9456 overexpression while lost its protective role when lnc9456 was deleted, further confirming lnc9456 as the bona fide target of HHQ16. We further identified the human ortholog of lnc9456, also an Egr2-affiliated transcript, lnc4012. Similarly, lnc4012 was significantly upregulated in hypertrophied failing hearts of patients with dilated cardiomyopathy. HHQ16 also specifically bound to lnc4012 and caused its degradation and antagonized its hypertrophic effects. Targeted degradation of pathological increased lnc4012/lnc9456 by small molecules might serve as a novel promising strategy to regress infarction-induced cardiac hypertrophy and HF.
Collapse
Affiliation(s)
- Jingjing Wan
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Zhen Zhang
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Chennan Wu
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Saisai Tian
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Yibei Zang
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Ge Jin
- School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Qingyan Sun
- China Institute of Pharmaceutical Industry, Shanghai, PR China
| | - Pin Wang
- Key Laboratory of Medical Immunology and Institute of Immunology, Second Military Medical University, Shanghai, PR China
| | - Xin Luan
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Yili Yang
- China Regional Research Centre, International Centre of Genetic Engineering & Biotechnology, Taizhou, PR China
| | - Xuelin Zhan
- China Regional Research Centre, International Centre of Genetic Engineering & Biotechnology, Taizhou, PR China
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin, PR China
| | - Lingyu Linda Ye
- Center for Phenomics of Traditional Chinese Medicine, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Southwest Medical University, Luzhou, PR China
| | - Dayue Darrel Duan
- Center for Phenomics of Traditional Chinese Medicine, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Southwest Medical University, Luzhou, PR China.
- Key Laboratory of Autoimmune Diseases and Precision Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, PR China.
| | - Xia Liu
- School of Pharmacy, Second Military Medical University, Shanghai, PR China.
| | - Weidong Zhang
- School of Pharmacy, Second Military Medical University, Shanghai, PR China.
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.
| |
Collapse
|
5
|
Melendo-Viu M, Dobarro D, Marchán López Á, Domínguez LM, Raposeiras-Roubín S, Abu-Assi E, Cardero-González C, Pérez-Expósito L, Cespón Fernández M, Parada Barcia JA, Barreiro Pérez M, García E, Íñiguez Romo A. Hypotension at heart failure discharge: Should it be a limiting factor for drug titration? Int J Cardiol 2023; 386:59-64. [PMID: 37169152 DOI: 10.1016/j.ijcard.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Medical treatment in Heart Failure (HF) with reduced ejection fraction (HFrEF; LVEF ≤40%) has shifted towards quadruple therapy. Maximum tolerated dose is the goal, yet no hypotension's cut-off point has been specified. In this work, we analyze the impact of intensive drug titration in clinical events, focusing on low blood pressure (BP) patients at hospital discharge. METHODS AND RESULTS Retrospective analysis of 713 patients with HFrEF discharged after an acute HF event (mean LVEF 30 ± 5%). Mean SBP was 112.4 ± 16.5 mmHg and 50.6% were discharged on triple therapy. We considered hypotension as a Systolic blood pressure (SBP) <100 mmHg (21.7% of patients, mean SBP was 112.4 ± 16.5 mmHg) and codified the intensity of drug therapy in 5 stages from untreated to very high therapy intensity. The impact of the intensity of treatment was analysed with a propensity score and increasing the intensity was associated in the whole cohort with a reduction of the composite outcome of all-cause mortality and HF readmission, (HR 0.69; CI95% 0.57-0.85, p < 0.001) and benefit in mortality was maintained for SBP < 100 mmHg (HR 0.42; CI95% 0.22-0.82; p = 0.011). Moreover, therapy intensity was clearly associated with lower risk of HF-hospitalization and death after the additional regression, considering SBP as a covariate, in the whole cohort (HR 0.70; CI95% 0.57-0.85; p < 0.001). CONCLUSIONS In this retrospective cohort analysis, patients with HFrEF and an acute-HF admission, intensive drug dose titration was related to better outcomes, even in patients with low blood pressure at hospital discharge. Therefore, hypotension is not a contraindication for NHB uptitration.
Collapse
Affiliation(s)
- Maria Melendo-Viu
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain; Faculty of Medicine, University Complutense of Madrid, Spain.
| | - David Dobarro
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | | | | | - Sergio Raposeiras-Roubín
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | - Emad Abu-Assi
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| | | | | | | | | | | | - Enrique García
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Andrés Íñiguez Romo
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain
| |
Collapse
|
6
|
Xu Y, Yang B, Hui J, Zhang C, Bian X, Tao M, Lu Y, Wang W, Qian H, Shang Z. The emerging role of sacubitril/valsartan in pulmonary hypertension with heart failure. Front Cardiovasc Med 2023; 10:1125014. [PMID: 37273885 PMCID: PMC10233066 DOI: 10.3389/fcvm.2023.1125014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Pulmonary hypertension due to left heart disease (PH-LHD) represents approximately 65%-80% of all patients with PH. The progression, prognosis, and mortality of individuals with left heart failure (LHF) are significantly influenced by PH and right ventricular (RV) dysfunction. Consequently, cardiologists should devote ample attention to the interplay between HF and PH. Patients with PH and HF may not receive optimal benefits from the therapeutic effects of prostaglandins, endothelin receptor antagonists, or phosphodiesterase inhibitors, which are specific drugs for pulmonary arterial hypertension (PAH). Sacubitril/valsartan, the angiotensin receptor II blocker-neprilysin inhibitor (ARNI), was recommended as the first-line therapy for patients with heart failure with reduced ejection fraction (HFrEF) by the 2021 European Society of Cardiology Guidelines. Although ARNI is effective in treating left ventricular (LV) enlargement and lower ejection fraction, its efficacy in treating individuals with PH and HF remains underexplored. Considering its vasodilatory effect at the pre-capillary level and a natriuretic drainage role at the post-capillary level, ARNI is believed to have a broad range of potential applications in treating PH-LHD. This review discusses the fundamental pathophysiological connections between PH and HF, emphasizing the latest research and potential benefits of ARNI in PH with various types of LHF and RV dysfunction.
Collapse
|
7
|
Martin TG, Juarros MA, Leinwand LA. Regression of cardiac hypertrophy in health and disease: mechanisms and therapeutic potential. Nat Rev Cardiol 2023; 20:347-363. [PMID: 36596855 PMCID: PMC10121965 DOI: 10.1038/s41569-022-00806-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/05/2023]
Abstract
Left ventricular hypertrophy is a leading risk factor for cardiovascular morbidity and mortality. Although reverse ventricular remodelling was long thought to be irreversible, evidence from the past three decades indicates that this process is possible with many existing heart disease therapies. The regression of pathological hypertrophy is associated with improved cardiac function, quality of life and long-term health outcomes. However, less than 50% of patients respond favourably to most therapies, and the reversibility of remodelling is influenced by many factors, including age, sex, BMI and disease aetiology. Cardiac hypertrophy also occurs in physiological settings, including pregnancy and exercise, although in these cases, hypertrophy is associated with normal or improved ventricular function and is completely reversible postpartum or with cessation of training. Studies over the past decade have identified the molecular features of hypertrophy regression in health and disease settings, which include modulation of protein synthesis, microRNAs, metabolism and protein degradation pathways. In this Review, we summarize the evidence for hypertrophy regression in patients with current first-line pharmacological and surgical interventions. We further discuss the molecular features of reverse remodelling identified in cell and animal models, highlighting remaining knowledge gaps and the essential questions for future investigation towards the goal of designing specific therapies to promote regression of pathological hypertrophy.
Collapse
Affiliation(s)
- Thomas G Martin
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Miranda A Juarros
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Leslie A Leinwand
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA.
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA.
| |
Collapse
|
8
|
Su J, Hu Y, Cheng J, Li Z, Li J, Zheng N, Zhang Z, Yang J, Li X, Yu Q, Du W, Chen X. Comprehensive analysis of the RNA transcriptome expression profiles and construction of the ceRNA network in heart failure patients with sacubitril/valsartan therapeutic heterogeneity after acute myocardial infarction. Eur J Pharmacol 2023; 944:175547. [PMID: 36708978 DOI: 10.1016/j.ejphar.2023.175547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
Sacubitril/valsartan has a noteworthy advantage in improving ventricular remodelling, as well as reducing cardiovascular mortality and the rate of heart failure (HF) readmission. However, clinically, some patients with HF still have low sensitivity to sacubitril/valsartan, indicating sacubitril/valsartan resistance (SVR). A total of 46 patients with HF after AMI (23 SVR and 23 non-sacubitril/valsartan resistance (NSVR)) were selected. Five SVR and 5 matched NSVR samples were screened for differentially expressed ncRNAs along with mRNAs. A total of 124 differentially expressed miRNAs, 137 circRNAs, 237 lncRNAs and 50 mRNAs were screened by RNA sequencing technology. After quantitative real-time PCR (qRT‒PCR) verification of selected biomarkers in 18 pairs of samples, we found that for patients with SVR, hsa-miR-543, hsa-miR-642b-5p, hsa-miR-760, hsa_circ_0137499, ENST00000474394, ENST00000528337, E2F1, NEAT1, and YTHDF2 were upregulated, and hsa-miR-424-5p, hsa-miR-21-3p, hsa_circRNA_0003275, hsa_circRNA_0004494, hsa_circ_0093522, ENST00000467951, ENST00000558177, ACTA2, ANPEP, and CAMP were downregulated. Then, with the help of our constructed ceRNA network and functional annotation enrichment, we speculated that inflammatory pathways (such as the apelin signalling pathway) and lipid metabolism pathways (such as fatty acid metabolism) may be involved in the regulation of SVR. These discoveries lay a foundation for further mechanistic research and provide a direction for individualized drug administration.
Collapse
Affiliation(s)
- Jia Su
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China
| | - Yingchu Hu
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China
| | - Ji Cheng
- Department of Emergency, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Zhenwei Li
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China
| | - Jiyi Li
- Department of Cardiology, Yuyao People's Hospital of Zhejiang Province, Yuyao, Zhejiang, PR China
| | - Nan Zheng
- Department of Cardiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Zhaoxia Zhang
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China
| | - Jin Yang
- Department of Geriatrics, Ningbo No. 1 Hospital, Ningbo, Zhejiang, PR China
| | - Xiaojin Li
- Department of Traditional Chinese Internal Medicine, Ningbo No. 1 Hospital, Ningbo, Zhejiang, PR China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo No. 1 Hospital, Ningbo, Zhejiang, PR China.
| | - Weiping Du
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China.
| | - Xiaomin Chen
- Department of Cardiology, Ningbo No.1 Hospital, Ningbo, Zhejiang, PR China; Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, PR China.
| |
Collapse
|
9
|
Chen WW, Jiang J, Gao J, Zhang XZ, Li YM, Liu YL, Dang HQ. Efficacy and safety of low-dose sacubitril/valsartan in heart failure patients: A systematic review and meta-analysis. Clin Cardiol 2023; 46:296-303. [PMID: 36648084 PMCID: PMC10018087 DOI: 10.1002/clc.23971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Controversy has persisted over the clinical benefits of low-dose sacubitril/valsartan in patients with heart failure (HF). HYPOTHESIS Low-dose sacubitril/valsartan might also be effective and safe in HF patients. METHODS Electronic databases including PubMed, Ovid, and Cochrane Library were systematically retrieved from inception to August 5, 2021. Review manager 5.4 and Stata 15.1 were employed in this systematic review and meta-analysis. Key efficacy outcomes of interest included HF hospitalization, all-cause mortality, left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), together with New York Heart Association (NYHA) functional class. The safety outcome was systolic blood pressure (SBP). The grading of recommendations assessment, development, and evaluation approach was conducted to evaluate the quality of evidence for each outcome. RESULTS A total of 1269 studies were screened and 9 real-world studies met the inclusion criteria were included in the meta-analysis, with 1697 participants. Compared with low-dose sacubitril/valsartan, high-dose sacubitril/valsartan significantly reduced the risk of HF hospitalization (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.27-0.61, p < .0001) and the risk of all-cause mortality (OR: 0.23, 95% CI: 0.11-0.47, p < .0001). However, there were no appreciable differences in improvements of NYHA (OR: 0.59, 95% CI: 0.15-2.35, p = .45), changes of LVEF (mean difference [MD]: 2.73%, 95% CI: -2.24% to 7.7%, p = .28), changes of NT-proBNP (MD: 43.09, 95% CI: -28.41 to 114.59, p = .24) and changes of SBP (MD: 3.01, 95% CI: -4.62 to 10.64, p = .44) between groups with low-dose and high-dose sacubitril/valsartan. CONCLUSIONS Compared with high-dose sacubitril/valsartan, low-dose sacubitril/valsartan was associated with increased risks of HF hospitalization and all-cause mortality. However, no distinct between-group differences in improvements of NYHA, changes of LVEF, changes of NT-proBNP and changes of SBP were observed.
Collapse
Affiliation(s)
- Wen-Wen Chen
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Juan Jiang
- Department of Stomatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Jie Gao
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Xiu-Zhen Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yuan-Min Li
- Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yan-Lin Liu
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - He-Qin Dang
- Department of Pharmacy, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| |
Collapse
|
10
|
Di Lenarda A, Di Gesaro G, Sarullo FM, Miani D, Driussi M, Correale M, Bilato C, Passantino A, Carluccio E, Villani A, degli Esposti L, d’Agostino C, Peruzzi E, Poli S, Iacoviello M. Sacubitril/Valsartan in Heart Failure with Reduced Ejection Fraction: Real-World Experience from Italy (the REAL.IT Study). J Clin Med 2023; 12:jcm12020699. [PMID: 36675628 PMCID: PMC9863394 DOI: 10.3390/jcm12020699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Sacubitril/valsartan reduces heart failure (HF)-related hospitalizations and cardiovascular mortality in PARADIGM-HF and has become a foundational treatment for HF with reduced ejection fraction (HFrEF). However, data of its routine real-world use are limited, and evidence from Italian settings is lacking. The REAL.IT study aimed to characterize the demographics, pharmacotherapy, clinical characteristics and outcomes of sacubitril/valsartan-treated Italian patients with HFrEF. Electronic medical records of patients initiating sacubitril/valsartan from October 2016 to June 2019 at nine specialized hospital outpatient HF centers across Italy were reviewed. Overall, 924 adults (mean age 64.5 years, 84.6% male) were included. At baseline, 38.7% had an ischemic HF etiology, 45.9% hypertension, 23.2% atrial fibrillation, 25.4% diabetes mellitus, 26.1% an implantable cardioverter-defibrillator and 31.9% coronary artery bypass grafting. There were no clear patterns of patient selection over time. During follow-up, NYHA class improved in 37.5% of patients after a mean of 5.3 ± 3.8 months; 36.1% and 16.7% of patients were in NYHA class III during characterization and after one year of follow-up, respectively. Left ventricular ejection fraction (LVEF) improved ≥5% in 56.3% of patients at one year; 39.7% had ≥30% reduction of N-terminal pro-B-type natriuretic peptide; 2.2% had hyperkalemia during characterization and 2.6% during follow-up; and 3.8% had hypotension during characterization and 12% during follow-up. A total of 50 (5.8%) of patients had device implantation (ICD/CRT) during follow-up. HF-related hospitalization was recorded in 19.6% of patients during follow-up; 3.8% of patients died, approximately 1.3% from cardiovascular causes. Our real-world data confirm the favorable effectiveness and tolerability of sacubitril/valsartan observed in pivotal randomized controlled trials.
Collapse
Affiliation(s)
- Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, 34128 Trieste, Italy
- Correspondence: (A.D.L.); (M.I.)
| | | | - Filippo Maria Sarullo
- U.O.S. Di Riabilitazione Cardiovascolare Ospedale Buccheri La Ferla Fatebenefratelli, 90123 Palermo, Italy
| | - Daniela Miani
- SOC Cardiologia, Dipartimento Cardiotoracico, Azienda Sanitaria Universitaria Friuli Centrale, Ospedale S. Maria della Misericordia, 33100 Udine, Italy
| | - Mauro Driussi
- SOC Cardiologia, Dipartimento Cardiotoracico, Azienda Sanitaria Universitaria Friuli Centrale, Ospedale S. Maria della Misericordia, 33100 Udine, Italy
| | - Michele Correale
- SC Universitaria di Cardiologia AOU “Ospedali Riuniti”, 71122 Foggia, Italy
| | - Claudio Bilato
- U.O.C. Cardiologia Azienda ULSS 8 Berica—Ospedali dell’Ovest Vicentino, 36071 Arzignano, Italy
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, U.O. Cardiologia ICS Maugeri SpA SB Bari, IRCCS Istituto di Bari, 70124 Bari, Italy
| | - Erberto Carluccio
- Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliera Universitaria “Santa Maria della Misericordia”, 06156 Perugia, Italy
| | - Alessandra Villani
- U.O. Day Hospital—MAC Cardiologia, Istituto Auxologico Italiano—Ospedale S. Luca, 20149 Milan, Italy
| | | | - Chiara d’Agostino
- Cardio-Metabolic Medical Manager, Novartis Farma SpA, 20154 Milan, Italy
| | - Elena Peruzzi
- Evidence Generation & Data Analytics Head, Novartis Farma SpA, 20154 Milan, Italy
| | - Simone Poli
- RWE Data Analyst, Novartis Farma SpA, 20154 Milan, Italy
| | - Massimo Iacoviello
- Surgical and Medical Sciences Department, University of Foggia, 71122 Foggia, Italy
- Correspondence: (A.D.L.); (M.I.)
| |
Collapse
|
11
|
Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, Del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Temporal trend and potential impact of angiotensin receptor neprilysin inhibitors on transcatheter edge-to-edge mitral valve repair. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:1001-1010. [PMID: 35272968 DOI: 10.1016/j.rec.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes. METHODS The population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n=450) and b) TEER after the recommendation of ARNIs by European Guidelines (n=639), with further analysis according to intake (n=52) or not (n=587) of ARNIs. RESULTS A total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82mL vs 100mL, P=.025), and better function (35% vs 38%, P=.011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P <.001) and heart failure readmissions (16.6% vs 27.8%, P <.001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission+mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P=.048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P=.011). CONCLUSIONS Better patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.
Collapse
Affiliation(s)
- Alejandro Barrero
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Fernando Carrasco-Chinchilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Tomás Benito-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Isaac Pascual
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Dabit Arzamendi
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | | | | | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Xavier Freixa
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Ramiro Trillo-Nouche
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Leire Andraka
- Departamento de Cardiología, Hospital Civil de Basurto, Bilbao, Vizcaya, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - José Luis Diez Gil
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Francisco Bosa
- Departamento de Cardiología, Hospital Universitario, Canarias, Spain
| | - Valeriano Ruiz
- Departamento de Cardiología, Complejo Hospitalario, Navarra, Spain
| | - María Del Trigo
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Eduardo Molina
- Departamento de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ana M Serrador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan H Alonso-Briales
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Carmen Garrote
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Pablo Avanzas
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Chi Hion Li
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | - José Antonio Baz
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Dolores Mesa
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Belén Cid
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Carrasco-Moraleja
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Tania Rodríguez-Gabella
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M Hernández-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Felipe Fernández-Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| |
Collapse
|
12
|
Kang Y, Yang ZX, Liu LL, Kong H, Wang H, Dong W, Bai L, Wang J, Sun ZJ, Zhang J, Li J, Guo YQ, Zhang Q. ARNI or ARB Treats Residual Left Ventricular Remodelling after Surgery for Valvular Regurgitation: ReReRe study protocol. ESC Heart Fail 2022; 9:3585-3592. [PMID: 35822565 DOI: 10.1002/ehf2.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS Patients with persistent or de novo left ventricular (LV) dilation and/or reduced ejection fraction (EF) after correction for primary aortic (AR) or mitral (MR) regurgitation (i.e. residual LV remodelling) have not been well studied with regard to guideline-directed medical therapy after successful aetiology-reversing surgery. We aim to (i) compare the effectiveness of sacubitril/valsartan vs. valsartan in promoting LV reverse remodelling and (ii) explore the safety of medication withdrawal after LV recovery. METHODS AND RESULTS The ReReRe study is a multicentre, randomized, open-label, parallel trial that consists of two consecutive parts. A total of 371 patients with an LV end-diastolic diameter (LVEDD) > 60 mm or LVEF < 50%, assessed by transthoracic echocardiography (TTE) 7-14 days after valve surgery for significant AR or primary MR will be enrolled. The 1st randomization into the sacubitril/valsartan or valsartan groups and structured follow-up (1, 3, 6, 9, and 12 months after randomization) will be conducted to observe the primary objective as the rate of complete recovery of LV remodelling (i.e. LVEDD < 55 mm and LVEF ≥ 60% by TTE at two consecutive visits). Those who have complete recovery of LV remodelling will be enrolled in Study Part 2; consequently, they will receive the 2nd randomization into the medication withdrawal or maintenance group and 6-monthly visits for the observation of the primary objective as the rate of LV remodelling relapse (LVEDD > 60 mm or LVEF < 50%). The secondary objectives include the rate of composite clinical outcomes and the degree of change in 6-min walk distance and Kansas City Cardiomyopathy Questionnaire scores. CONCLUSIONS The ReReRe study will provide new evidence for the treatment of patients with residual LV remodelling after curable unloaded surgery, as well as the duration of treatment. The study results will fill the gap in identifying an appropriate medical therapy regimen for this group of patients and perhaps for those with reversible aetiologies of heart failure.
Collapse
Affiliation(s)
- Yu Kang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Xuan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu-Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Kong
- The Heart Failure Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Dong
- Department of Cardiology, The Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Ling Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Cardiology, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
13
|
Straining for Surrogacy. JACC Cardiovasc Imaging 2022; 15:1542-1544. [DOI: 10.1016/j.jcmg.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
|
14
|
Visco V, Radano I, Campanile A, Ravera A, Silverio A, Masarone D, Pacileo G, Correale M, Mazzeo P, Dattilo G, Giallauria F, Cuomo A, Mercurio V, Tocchetti CG, Di Pietro P, Carrizzo A, Citro R, Galasso G, Vecchione C, Ciccarelli M. Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF. ESC Heart Fail 2022; 9:2909-2917. [PMID: 35702942 DOI: 10.1002/ehf2.13982] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all-cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up-titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up-titration success. METHODS AND RESULTS From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1-72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P-value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV-FW-LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794-0.954) to predict maximum Sac/Val dose tolerability. CONCLUSIONS Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE <16 mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses.
Collapse
Affiliation(s)
- Valeria Visco
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Ilaria Radano
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alfonso Campanile
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Amelia Ravera
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Angelo Silverio
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | | | | | - Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Pietro Mazzeo
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Operative Unit of Cardiology, University of Messina, Messina, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy.,Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Paola Di Pietro
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Albino Carrizzo
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Rodolfo Citro
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Gennaro Galasso
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Carmine Vecchione
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Michele Ciccarelli
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| |
Collapse
|
15
|
Reverse Remodeling Assessed by Left Atrial and Ventricular Strain Reflects Treatment Response to Sacubitril/Valsartan. JACC: CARDIOVASCULAR IMAGING 2022; 15:1525-1541. [DOI: 10.1016/j.jcmg.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022]
|
16
|
Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Cambios en la selección e impacto potencial de los inhibidores de neprilisina y del receptor de la angiotensina en los pacientes sometidos a reparación mitral percutánea borde a borde. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
17
|
Onishi H, Izumo M, Naganuma T, Nakamura S, Akashi YJ. Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future. Front Cardiovasc Med 2022; 9:883450. [PMID: 35548414 PMCID: PMC9081364 DOI: 10.3389/fcvm.2022.883450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed.
Collapse
Affiliation(s)
- Hirokazu Onishi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Masaki Izumo
| | - Toru Naganuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
18
|
Hnat T, Veselka J, Honek J. Left ventricular reverse remodelling and its predictors in non-ischaemic cardiomyopathy. ESC Heart Fail 2022; 9:2070-2083. [PMID: 35437948 PMCID: PMC9288763 DOI: 10.1002/ehf2.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new‐onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter‐defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non‐ischaemic cardiomyopathy, as well as on novel drugs, is presented.
Collapse
Affiliation(s)
- Tomas Hnat
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Jakub Honek
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| |
Collapse
|
19
|
Russo V, Ammendola E, Gasperetti A, Bottino R, Schiavone M, Masarone D, Pacileo G, Nigro G, Golino P, Lip GYH, D'Andrea A, Boriani G, Proietti R. Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients. J Cardiovasc Pharmacol 2022; 79:472-478. [PMID: 34935699 PMCID: PMC9012526 DOI: 10.1097/fjc.0000000000001202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT No data on the add-on sacubitril/valsartan (S/V) therapy among cardiac resynchronization therapy with a defibrillator (CRT-D) nonresponder patients are currently available in literature. We conducted a prospective observational study including 190 CRT-D nonresponder patients with symptomatic heart failure with reduced ejection fraction despite the optimal medical therapy from at least 1 year. The primary endpoint was the rate of additional responders (left ventricular end-systolic volume reduction >15%) at 12 months from the introduction of S/V therapy. At the end of the 12 months follow-up, 37 patients (19.5%) were deemed as "additional responders" to the combination use of CRT + S/V therapy. The only clinical predictor of additional response was a lower left ventricular ejection fraction [OR 0.881 (0.815-0.953), P = 0.002] at baseline. At 12 months follow-up, there were significant improvements in heart failure (HF) symptoms and functional status [New York Heart Association 2 (2-3) vs. 1 (1-2), P < 0.001; physical activity duration/day: 10 (8-12) vs. 13 (10-18) hours, P < 0.001]. Compared with the 12 months preceding S/V introduction, there were significant reductions in the rate of HF rehospitalization (35.5% vs. 19.5%, P < 0.001), in atrial tachycardia/atrial fibrillation burden [6.0 (5.0-8.0) % vs. 0 (0-2.0) %, P < 0.001] and in the proportions of patients experiencing ventricular arrhythmias (21.6% vs. 6.3%; P < 0.001). Our results indicate that S/V add-on therapy in CRT-D nonresponder patients is associated with 19.5% of additional responders, a reduction in HF symptoms and rehospitalizations, AF burden, and ventricular arrhythmias.
Collapse
Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Roberta Bottino
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Daniele Masarone
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, Salerno, Italy; and
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Proietti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
20
|
Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction. Sci Rep 2021; 11:22342. [PMID: 34785723 PMCID: PMC8595580 DOI: 10.1038/s41598-021-01759-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/03/2021] [Indexed: 12/11/2022] Open
Abstract
Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium–glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e′ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.
Collapse
|
21
|
Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan. Diagnostics (Basel) 2021; 11:diagnostics11101845. [PMID: 34679543 PMCID: PMC8534459 DOI: 10.3390/diagnostics11101845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 12/11/2022] Open
Abstract
In terms of sacubitril/valsartan (S/V)-induced changes in heart failure with reduced ejection fraction (HFrEF) via three-dimensional (3D) transthoracic echocardiography (TTE) and S/V effects based on HF aetiology, data are lacking. We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-month follow-up (6MFU) after S/V treatment optimisation, we assessed the N-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac remodelling by two-dimensional (2D) and 3DTTE. In non-ischaemic patients, 2D and 3DTTE showed an improvement in left ventricular (LV) size and biventricular function at 6MFU vs. baseline: 3D-LV end-diastolic volume (EDV) 103 ± 30 vs. 125 ± 32 mL/m2 (p < 0.05), 3D-LV ejection fraction (EF) 40 ± 9 vs. 32 ± 5% (p < 0.05), right ventricular (RV) 3D-EF 48.4 ± 6.5 vs. 44.3 ± 7.5% (p < 0.05); only the 3D method detected RV size reduction: 3D-RVEDV 63 ± 27 vs. 71 ± 30 mL/m2 (p < 0.05). In ischaemic patients, only 3DTTE showed biventricular size and LV function improvement: 3D-LVEDV 112 ± 29 vs. 121 ± 27 mL/m2 (p < 0.05), 3D-LVEF 35 ± 6 vs. 32 ± 5% (p < 0.05), 3D-RVEDV 57 ± 11 vs. 63 ± 14 mL/m2 (p < 0.05); RV function did not ameliorate. In both ischaemic and non-ischaemic patients, diastolic function and NT-proBNP significantly improved. In HFrEF patients treated with S/V, 3DTTE helps to ascertain subtle changes in heart chambers’ size and function, which have a major impact on HFrEF prognosis. S/V has significantly different effects on LV function in non-ischaemic vs. ischaemic patients.
Collapse
|
22
|
Gu W, Xu C, Li Z, Li ZZ. Echocardiographic changes in elderly patients with heart failure with reduced ejection fraction after sacubitril-valsartan treatment. Cardiovasc Diagn Ther 2021; 11:1093-1100. [PMID: 34815959 PMCID: PMC8569280 DOI: 10.21037/cdt-21-355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND To observe the changes of cardiac structure and function in elderly patients with heart failure with reduced ejection fraction (HFrEF) after taking Sacubitril-Valsartan for 6 months. METHODS Elderly patients with HFrEF hospitalized in Beijing Anzhen Hospital from May 2019 to May 2020 were enrolled continuously in the single-center, retrospective, cohort study. Patients' Echocardiographs were examined for the evaluation of their cardiac condition. The primary outcomes were changes in cardiac function and structure at the sixth month after discharge, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular mass index (LVMI). RESULTS A total of 336 elderly patients with HFrEF were enrolled in this study, with an average age of 69.8 years, including 268 males (79.8%). Compared to the admission levels, the LVEF after taking Sacubitril-Valsartan for 6 months was markedly improved (48.49% vs. 39.07%, P<0.01), while the LVEDD (54.70 vs. 59.97 mm, P<0.01), LVESD (40.59 vs. 47.59 mm, P<0.01), LAD (48.59 vs. 52.45 mm, P<0.01) and LVMI (105.16 vs. 125.20 g/m2, P<0.01) decreased. Similar results were obtained in the subgroups of patients who were diagnosed with HFrEF on admission. In men, NHYA II and NHYA III subgroups, cardiac function improved significantly. CONCLUSIONS Sacubitril-Valsartan can improve the cardiac function and structure of elderly patients with HFrEF.
Collapse
Affiliation(s)
- Wei Gu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chuangye Xu
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Zhao Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhi-Zhong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| |
Collapse
|
23
|
Ai J, Shuai Z, Tang K, Li Z, Zou L, Liu M. Sacubitril/valsartan alleviates myocardial fibrosis in diabetic cardiomyopathy rats. Hellenic J Cardiol 2021; 62:389-391. [PMID: 33957252 DOI: 10.1016/j.hjc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jiao Ai
- Department of Internal Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhuang Shuai
- Department of Internal Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kai Tang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Zongyu Li
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Luwei Zou
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Mao Liu
- Department of Cardiology, Cardiovascular Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Internal Medicine, Quxian People's Hospital, Dazhou, China.
| |
Collapse
|
24
|
Moon MG, Hwang IC, Choi W, Cho GY, Yoon YE, Park JB, Lee SP, Kim HK, Kim YJ. Reverse remodelling by sacubitril/valsartan predicts the prognosis in heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:2058-2069. [PMID: 33682334 PMCID: PMC8120366 DOI: 10.1002/ehf2.13285] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Despite well‐established benefits of sacubitril/valsartan for cardiac reverse remodelling and the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), there are some patients with limited therapeutic response, even with optimal therapy. We assessed the treatment response to sacubitril/valsartan in patients with HFrEF, focusing on the association between reverse remodelling and the prognosis. Methods and results Using a retrospective cohort of consecutive patients with HFrEF treated with sacubitril/valsartan, we compared the time trajectory of cardiac function in 415 patients (1258 echocardiograms), according to the occurrence of cardiovascular death and hospitalization for HF during a median follow‐up of 19.1 (interquartile range, 10.9–27.6) months. A higher sacubitril/valsartan dose was associated with a better prognosis, whereas advanced age, diabetes, left ventricular (LV) hypertrophy, left atrial enlargement, and pulmonary hypertension were associated with a worse prognosis. Patients without an event (n = 337; 81.2%) showed LV reverse remodelling (LV ejection fraction ≥45% or LV end‐systolic volume reduction by 15% from baseline), which was typically observed within 6 months of sacubitril/valsartan treatment. Reverse remodelling achievement was significantly associated with a better prognosis. However, patients without reverse remodelling had a worse prognosis, as poor as that in patients with HFrEF not treated with sacubitril/valsartan. Conclusions In patients with HFrEF treated with sacubitril/valsartan, LV reverse remodelling reflects the treatment response and predicts the prognosis, whereas a lack of reverse remodelling indicates the lack of treatment benefits. Prediction and assessment of reverse remodelling may facilitate the selection of patients with greater benefits by sacubitril/valsartan.
Collapse
Affiliation(s)
- Mi-Gil Moon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Wonsuk Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|