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Correale M, Pelaggi G, Catanoso MC, Miccichè S, Teresi L, Bonanno S, Bellocchi P, Poleggi C, Capasso R, Barile M, Visco V, Carluccio E, Nodari S, Ciccarelli M, Dattilo G. Vericiguat in heart failure with reduced ejection fraction: hope or solid reality? Heart Fail Rev 2024:10.1007/s10741-024-10425-7. [PMID: 39044114 DOI: 10.1007/s10741-024-10425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
In recent years, thanks to the advent of new classes of drugs (ARNI and SGLT2-i), the prognosis of patients suffering from heart failure with reduced ejection fraction (HFrEF) has gradually improved. Nonetheless, there is a residual risk that is not targeted by these therapies. Currently, it is recognized that vericiguat, an oral stimulator of soluble guanylate cyclase (sGC), can restore the NO-sGC-cGMP pathway, through stimulation and activation of sGC, aiming to increase cGMP levels with a reduction in heart failure-related oxidative stress and endothelial dysfunction. Even though the Victoria trial demonstrated that HFrEF patients in treatment with vericiguat showed a 10% reduction in the composite of cardiovascular mortality and rehospitalization for heart failure, statistically significantly reducing heart failure hospitalization, the international guidelines limit its use as a second-line drug for patients with worsening symptomatology despite optimized medical therapy. Furthermore, vericiguat has proved to be a valid therapeutic ally especially in those patients with comorbidities such that they cannot receive the classic four-pillar therapy of HF (in particular renal failure). In this review, the authors report on randomized clinical trials, substudies, and meta-analysis about vericiguat in HFrEF, emphasizing the strengths that would suggest the possible role of vericiguat as the fifth pillar of the HFrEF treatment, acknowledging that there are still gaps in the evidence that need to be clarified.
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Affiliation(s)
- Michele Correale
- Cardiothoracic Department, Policlinico Riuniti University Hospital, Foggia, Italy.
| | - Giuseppe Pelaggi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Maria Concetta Catanoso
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Serena Miccichè
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Lucio Teresi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Salvatore Bonanno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Paolo Bellocchi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
| | - Raffaele Capasso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Barile
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Via Salvador Allende, 84081, Baronissi, Italy
| | - Giuseppe Dattilo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
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Dattilo G, Laterra G, Licordari R, Parisi F, Pistelli L, Colarusso L, Zappia L, Vaccaro V, Demurtas E, Allegra M, Crea P, Di Bella G, Signorelli SS, Aspromonte N, Imbalzano E, Correale M. The Long-Term Benefit of Sacubitril/Valsartan in Patients with HFrEF: A 5-Year Follow-Up Study in a Real World Population. J Clin Med 2023; 12:6247. [PMID: 37834892 PMCID: PMC10573839 DOI: 10.3390/jcm12196247] [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: 08/30/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Heart failure (HF) is a progressive condition with an increasing prevalence, and the scientific evidence of heart failure with reduced ejection fraction (HFrEF) reports a 6% rate of 1-year mortality in stable patients, whereas, in recently hospitalized patients, the 1-year mortality rates exceed 20%. The Sacubitril/Valsartan (S/V), the first angiotensin receptor neprilysin inhibitor (ARNI), significantly reduced both HF hospitalization and cardiovascular mortality. AIM OF THE STUDY to evaluate the effect of S/V in a follow-up period of 5 years from the beginning of the therapy. We compared the one-year outcomes of S/V use with those obtained after 5 years of therapy, monitoring the long-term effects in a real-world population with HFrEF. METHODS Seventy consecutive patients with HFrEF and eligible for ARNI, according to PARADIGM-HF criteria, were enrolled. All patients had an overall follow-up of 60 months, during which time they underwent standard transthoracic echocardiography (TTE) with Global Longitudinal Strain (GLS) evaluation, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Six Minutes Walking Test (6MWT), and blood tests (NT-pro-BNP and BNP, renal function tests). RESULTS NTproBNP values were reduced significantly among the three time-points (p < 0.001). Among echocardiographic parameters, left ventricle end-diastolic volume (LV EDV) and E/e' significantly were reduced at the first evaluation (12 months), while left ventricle end-systolic volume (LV ESV) decreased during all follow-ups (p < 0.001). LV EF (p < 0.001) and GLS (p < 0.001) significantly increased at both evaluations. The 6MWT (p < 0.001) and KCCQ scores (p < 0.001) increased significantly in the first 12 months and remained stable along the other time-points. NYHA class showed an increase in class 1 subjects and a decrease in class 3 subjects during follow-up. NTproBNP, BNP, 6MWT, and KCCQ scores showed a significant change in the first 12 months, while LVEF, GLS, and ESV changed during all evaluations. CONCLUSIONS We verified that the improvements obtained after one year of therapy had not reached a plateau phase but continued to improve and were statistically significant at 5 years. Although our data should be confirmed in larger and multicentre studies, we can state that the utilization of Sacubitril/Valsartan has catalysed substantial transformations in the prognostic landscape of chronic HFrEF, yielding profound clinical implications.
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Affiliation(s)
- Giuseppe Dattilo
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy; (G.D.); (R.L.)
| | - Giulia Laterra
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Roberto Licordari
- Section of Cardiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy; (G.D.); (R.L.)
| | - Francesca Parisi
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Lorenzo Pistelli
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Luigi Colarusso
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Luca Zappia
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Vittoria Vaccaro
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Elisabetta Demurtas
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Marta Allegra
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Pasquale Crea
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Salvatore Santo Signorelli
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy;
| | - Nadia Aspromonte
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Policlinic University Hospital of Messina, 98122 Messina, Italy; (G.L.); (F.P.); (L.P.); (L.C.); (L.Z.); (V.V.); (E.D.); (M.A.); (P.C.); (G.D.B.)
| | - Michele Correale
- Cardiothoracic Department, Policlinico Riuniti University Hospital, 71100 Foggia, Italy;
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Luzza F, De Sarro R, Licordari R, Crea P, Pugliatti P, Certo G, Pistelli L, Campanella F, Lo Nigro MC, Casale M, Correale M, Dattilo G. Atrial fibrillation and QT corrected. What is the best formula to use? Eur J Clin Invest 2023; 53:e14013. [PMID: 37144525 DOI: 10.1111/eci.14013] [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: 02/12/2023] [Revised: 04/15/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND QT interval varies with the heart rate (HR), so a correction in QT calculation is needed (QTc). Atrial fibrillation (AF) is associated with elevated HR and beat-to-beat variation. AIM To find best correlation between QTc in atrial fibrillation (AF) versus restored sinus rhytm (SR) after electrical cardioversion (ECV) (primary end point) and to determine which correction formula and method are the best to determine QTc in AF (secondary end point). METHODS During a 3-month period, we considered patients who underwent 12-lead ECG recording and received an AF diagnosis with indication for ECV. Exclusion criteria were as follows: QRS duration >120 ms, therapy with QT-prolonging drugs, a rate control strategy and a nonelectrical cardioversion. The QT interval was corrected using Bazzett's, Framingham, Fridericia and Hodges formulas during the last ECG during AF and the first one immediately after ECV. QTc mean was calculated as mQTc (average of 10 QTc calculated beat per beat) and as QTcM (QTc calculated from the average of 10 raw QT and RR for each beat). RESULTS Fifty consecutive patients were enrolled in the study. Bazett's formula showed a significant change in mean QTc value between the two rhythms (421.5 ± 33.9 vs. 446.1 ± 31.9; p < 0.001 for mQTc and 420.9 ± 34.1 vs. 441.8 ± 30.9; p = 0.003 for QTcM). On the contrary, in patients with SR, QTc assessed by the Framingham, Fridericia, and Hodges formulas was similar to that in AF. Furthermore, good correlations between mQTc and QTcM are present for each formula, even in AF or SR. CONCLUSIONS During AF, Bazzett's formula, seems to be the most imprecise in QTc estimation.
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Affiliation(s)
- Francesco Luzza
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosalba De Sarro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pietro Pugliatti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Certo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Lorenzo Pistelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Campanella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Matteo Casale
- Operative Unit of ICCU and Cardiology, Hospital "S. Maria della Misericordia", Urbino, Italy
| | - Michele Correale
- Cardiothoracic Department, Policlinico Riuniti University Hospital, Foggia, Italy
| | - Giuseppe Dattilo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, Messina, Italy
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Anomalous origin of the left circumflex artery from right sinus of Valsalva: a rare case but with great clinical relevance. COR ET VASA 2023. [DOI: 10.33678/cor.2022.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Correale M, Magnesa M, Mazzeo P, Fortunato M, Tricarico L, Leopizzi A, Mallardi A, Mennella R, Croella F, Iacoviello M, Di Biase M, Brunetti ND. Left Atrial Functional Remodeling in Patients with Chronic Heart Failure Treated with Sacubitril/Valsartan. J Clin Med 2023; 12:jcm12031086. [PMID: 36769734 PMCID: PMC9917469 DOI: 10.3390/jcm12031086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
(1) Background: Previous studies showed left ventricular (LV) and left atrial (LA) improvement and reverse remodeling after therapy with Sacubitril/Valsartan (S/V) in patients affected by heart failure with reduced ejection fraction (HFrEF). Therefore, we sought to investigate predictors of LA structural and functional reverse remodeling (LARR) in this setting of patients after therapy with S/V, focusing on left atrial strain parameters, such as peak atrial longitudinal strain (PALS). (2) Methods: Patients with HFrEF underwent clinical and echocardiographic evaluation at baseline and after six months of therapy with S/V. Measures of LA structure (LA volume index, LAVi) and function (LA emptying fraction (LAEF), PALS, LA conduit strain and peak atrial contraction strain (PACS) were also analyzed. Patients were divided in two groups, those with a LARR (relative reduction in LAVi > 15%, LARR+) and those without (LARR-). (3) Results: A total of 47 consecutive patients (66 ± 8 years, 85% male, mean LVEF 28 ± 6%) were enrolled in the study and followed up. A significant increase of LAEF (46 ± 13 vs. 37 ± 11%, p < 0.001) and a significant reduction of LAVi (42 ± 15 vs. 45 ± 15 mL/m2, p = 0.008) were found after 6 months of S/V therapy; 47% of the population showed LA reverse remodeling. LA strain parameters, PALS (19 ± 8 vs. 15 ± 7 %, p < 0.001) and LA conduit (-9.7 ± 5.2% vs. -7.6 ± 4.1%, p = 0.007) significantly improved after 6 months of S/V therapy. At multivariable stepwise regression analysis, changes in LV End Diastolic Volume (LVEDV) and PALS were significantly proportional to changes in LAVi values. (4) Conclusions: Six months of treatment with S/V in patients with HFrEF was associated with an improvement in LA functional reverse remodeling in a real-world scenario. LARR was not significantly correlated to baseline echocardiographic variables, but was proportional to changes in LV volumes and LA strain parameters. Finally, after S/V therapy, a strict connection between LA and LV reverse remodeling and between LA anatomical and functional reverse remodeling seems to be outlined.
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Affiliation(s)
- Michele Correale
- Cardiology Unit, Cardio-Thoracic Department, Policlinico Riuniti University Hospital, Viale Luigi Pinto 1, 71100 Foggia, Italy
| | - Michele Magnesa
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Martino Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Alessandra Leopizzi
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Adriana Mallardi
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Raffaele Mennella
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Francesca Croella
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
- Correspondence: ; Tel.: +39-338-9112358; Fax: +39-0881-745424
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PaceMaker lead and atrial thrombosis, a rare event but of high clinical importance. COR ET VASA 2022. [DOI: 10.33678/cor.2021.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wei Z, Zhang M, Zhang Q, Gong L, Wang X, Wang Z, Gao M, Zhang Z. A narrative review on sacubitril/valsartan and ventricular arrhythmias. Medicine (Baltimore) 2022; 101:e29456. [PMID: 35801732 PMCID: PMC9259167 DOI: 10.1097/md.0000000000029456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sacubitril/valsartan, the first angiotensin receptor neprilysin inhibitor approved by the Food and Drug Administration for marketing, has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in patients with chronic heart failure with a reduced ejection fraction. However, some researchers have also found that sacubitril/valsartan has an antiarrhythmic effect. The mechanism by which sacubitril/valsartan reduces the mortality associated with malignant ventricular arrhythmias is not precise. Many studies have concluded that ventricular arrhythmia is associated with a reduction in myocardial fibrosis. This article reviews the current understanding of the effects of sacubitril/valsartan on the reduction of ventricular arrhythmia and explains its possible mechanisms. The results of this study suggest that sacubitril/valsartan reduces the occurrence of appropriate implantable cardioverter-defibrillator shocks. Meanwhile, sacubitril/valsartan may reduce the occurrence of ventricular arrhythmias by affecting 3 pathways of B-type natriuretic peptide, Angiotensin II, and Bradykinin. The conclusion of this study is that sacubitril/valsartan reduces the number of implantable cardioverter-defibrillator shocks and ventricular arrhythmias in heart failure with reduced ejection fraction patients.
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Affiliation(s)
- Zhaoyang Wei
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Meiwei Zhang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qian Zhang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Linan Gong
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiangyu Wang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zanzan Wang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ming Gao
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhiguo Zhang
- Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province, China
- * Correspondence: Zhiguo Zhang, MD, Department of Cardiology, the First Hospital of Jilin University, Changchun, Jilin Province 130021, China (e-mail: )
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The power and wisdom of prevention. Cardiovascular risk, new challenge, and approach to PLWH. COR ET VASA 2022. [DOI: 10.33678/cor.2021.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adipsin as a novel prognostic biomarker for cardiovascular diseases. COR ET VASA 2022. [DOI: 10.33678/cor.2021.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tako-tsubo syndrome and atrial fibrillation. New trigger for cardiomyopathy. A clinical case. COR ET VASA 2022. [DOI: 10.33678/cor.2021.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pastore MC, Mandoli GE, Giannoni A, Benfari G, Dini FL, Pugliese NR, Taddei C, Correale M, Brunetti ND, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Degiovanni A, Patti G, Santoro C, Moderato L, Malagoli A, Emdin M, Cameli M, Rosa G, Magnesa M, Mazzeo P, De Carli G, Bellino M, Iuliano G, Casciano O, Binno S, Canepa M, Tondi S, Cicoira M, Mega S. Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeab046. [PMID: 35919657 PMCID: PMC9242049 DOI: 10.1093/ehjopen/oeab046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/03/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
Aims This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors. Methods and results In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical, and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had no indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV) ejection fraction (EF) ≤ 35% and New York Heart Association (NYHA) class = II-III, 69 (60%) did not show ICD indications; 44 (40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation > moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With receiver operating characteristic curves, age ≥ 75 years, LAVi ≥ 42 mL/m2 and LV GLS ≥-8.3% were associated with ICD indications persistence (area under the curve = 0.65, 0.68, 0.68, respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Frank Lloyd Dini
- Centro Medico Sant’Agostino, via Temperanza 6, 20127 Milano, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
| | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Salerno, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Via Paolo Solaroli, 17, 28100 Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Via Balbi 5, 16126 Genova, Italy
| | - Michele Magnesa
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Giuseppe De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Michele Bellino
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Giuseppe Iuliano
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Ofelia Casciano
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Simone Binno
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Largo Rosanna Benzi, 10, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, Via Balbi 5, 16126 Genova, Italy
| | - Stefano Tondi
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Mariantonietta Cicoira
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Simona Mega
- Cardiocenter and Unit of Cardiology, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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Casale M, Mezzetti M, Gigliotti De Fazio M, Caccamo L, Busacca P, Dattilo G. Novel active fixation lead guided by electrical delay can improve response to cardiac resynchronization therapy in heart failure. ESC Heart Fail 2021; 9:146-154. [PMID: 34953050 PMCID: PMC8788056 DOI: 10.1002/ehf2.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/24/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) for heart failure (HF) recently has shown optimal results by targeting electrically delayed sites in coronary sinus (CS) branches. However this purpose often cannot be reached because of unstable left ventricular (LV) lead position. In current study were assessed the long-term effects of the novel active fixation LV lead in CS, guided by electrical delay (QLV), in patients with HF due to coronary artery disease. METHODS One hundred eighty-five consecutive patients underwent CRT with intraoperative evaluation of QLV in the target position of the LV lead. When the novel active fixation LV lead was available, 98 consecutive patients received it, composing the Fix group. They were compared with 87 patients with a conventional passive fixation lead (No Fix group). The final LV lead position was assessed by fluoroscopy. Clinical response to CRT was assessed within a period of about 3 years: patients experiencing HF rehospitalization and death due to HF were defined as non-responders. RESULTS There were no significant differences between groups in the final position of LV lead in left anterior oblique view (Pearson χ2 = 0.12; P = 0.73). In right anterior oblique view, a basal position was reached more in the Fix group (38%) than in the No Fix group (6.5%) (Pearson χ2 = 23.095; P < 0.001). QLV was significantly greater in the Fix group (122.6 ± 33.2 ms; SE = 3.6) than in the No Fix group (97.5 ± 37.8 ms; SE = 4.9) (t = 4.17; P < 0.001). Rehospitalizations for HF were 37 in the No Fix group and 14 in the Fix group. Deaths due to HF were 49 in the No Fix group and 18 in the Fix group. Survival analysis, assessed by Cox regression, showed that the Fix group had a better outcome both for HF rehospitalizations [hazard ratio (HR) = 0.48; 95% confidence interval (CI) = 0.25-0.9; P = 0.023] and death due to HF (HR = 0.55; 95% CI = 0.31-0.97; P = 0.04) in comparison with the No Fix group. Adjustment for baseline characteristics by multivariate analysis showed that an active fixation lead in CS, as a covariate, was still significant both for HF rehospitalizations (HR 0.46; 95% CI = 0.24-0.88; P = 0.019) and for death due to HF (HR 0.5; 95% CI = 0.28-0.9; P = 0.021). CONCLUSIONS The novel active fixation LV lead allowed to target sites with greater QLV. Often maximum QLV was documented in basal segments, were stability of conventional passive fixation leads is not enough. Patients receiving it experienced less HF rehospitalizations and less death due to HF. Active fixation lead in CS guided by QLV can improve long-term prognosis in patients with HF due to coronary artery disease undergoing to CRT.
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Affiliation(s)
- Matteo Casale
- ASUR Marche - Area Vasta 1, Operative Unit of ICCU and Cardiology, Hospital S. Maria della Misericordia, Urbino, Italy
| | - Maurizio Mezzetti
- ASUR Marche - Area Vasta 1, Operative Unit of ICCU and Cardiology, Hospital S. Maria della Misericordia, Urbino, Italy
| | - Marianna Gigliotti De Fazio
- Department of Clinical and Experimental Medicine, Operative Unit of Internal Medicine, University of Messina, Messina, Italy
| | - Loredana Caccamo
- ASUR Marche - Area Vasta 1, Operative Unit of ICCU and Cardiology, Hospital S. Maria della Misericordia, Urbino, Italy
| | - Paolo Busacca
- ASUR Marche - Area Vasta 1, Operative Unit of ICCU and Cardiology, Hospital S. Maria della Misericordia, Urbino, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Operative Unit of Cardiology, University of Messina, Messina, Italy
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13
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Chronic heart failure and hypotensive effects of sacubitril/valsartan. A clinical case. COR ET VASA 2021. [DOI: 10.33678/cor.2021.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Corrado E, Dattilo G, Coppola G, Morabito C, Bonni E, Zappia L, Novo G, de Gregorio C. Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients. Eur J Clin Pharmacol 2021; 78:19-25. [PMID: 34554274 PMCID: PMC8458558 DOI: 10.1007/s00228-021-03210-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022]
Abstract
Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, 6-min walk test and strain echocardiography were performed in each patient on a regular basis during the observational period. At the end of the study, patients were divided into two groups based on the median yearly dose of the ARNI medication. Results A total of 90 patients, 64 ± 11 years, 82% males, were enrolled. The cut-off dose was established in 75 mg BID, and the study population was divided into group A (≤ 75 mg), 52 patients (58%), and group B (> 75 mg), 38 patients (42%). The follow-up duration was 12 months (range 11–13). NYHA class, KCCQ score and 6MWT performance ameliorated in both groups, with a quicker time to benefit in group B. The proportion of patients walking > 350 m increased from 21 to 58% in group A (p < 0.001), and from 29 to 82% in group B (p < 0.001). A positive effect was also disclosed in the left ventricular remodelling, strain deformation and diastolic function. Conclusion One-year ARNI treatment was effective in our real-life HFrEF patient population, leading to clinical and functional improvement in both study groups, slightly greater and with a shorter time to benefit in group B. Supplementary information The online version contains supplementary material available at 10.1007/s00228-021-03210-0.
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Affiliation(s)
- Egle Corrado
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Giuseppe Coppola
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Claudia Morabito
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Enrico Bonni
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Luca Zappia
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Division of Cardiology, University of Palermo, University Hospital of Palermo, Palermo, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Division of Cardiology, Heart Failure Outpatient Unit, University of Messina, Messina, Italy.
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Angiotensin Receptor-Neprilysin Inhibitor (ARNI) and Cardiac Arrhythmias. Int J Mol Sci 2021; 22:ijms22168994. [PMID: 34445698 PMCID: PMC8396594 DOI: 10.3390/ijms22168994] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays a major role in cardiovascular health and disease. Short-term RAAS activation controls water and salt retention and causes vasoconstriction, which are beneficial for maintaining cardiac output in low blood pressure and early stage heart failure. However, prolonged RAAS activation is detrimental, leading to structural remodeling and cardiac dysfunction. Natriuretic peptides (NPs) are activated to counterbalance the effect of RAAS and sympathetic nervous system by facilitating water and salt excretion and causing vasodilation. Neprilysin is a major NP-degrading enzyme that degrades multiple vaso-modulatory substances. Although the inhibition of neprilysin alone is not sufficient to counterbalance RAAS activation in cardiovascular diseases (e.g., hypertension and heart failure), a combination of angiotensin receptor blocker and neprilysin inhibitor (ARNI) was highly effective in several clinical trials and may modulate the risk of atrial and ventricular arrhythmias. This review summarizes the possible link between ARNI and cardiac arrhythmias and discusses potential underlying mechanisms, providing novel insights about the therapeutic role and safety profile of ARNI in the cardiovascular system.
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