1
|
Martínez-Falguera D, Aranyó J, Teis A, Ferrer-Curriu G, Monguió-Tortajada M, Fadeuilhe E, Rodríguez-Leor O, Díaz-Güemes I, Roura S, Villuendas R, Sarrias A, Bazan V, Delgado V, Bayes-Genis A, Bisbal F, Gálvez-Montón C. Antiarrhythmic and Anti-Inflammatory Effects of Sacubitril/Valsartan on Post-Myocardial Infarction Scar. Circ Arrhythm Electrophysiol 2024; 17:e012517. [PMID: 38666379 DOI: 10.1161/circep.123.012517] [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: 10/02/2023] [Accepted: 02/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Sacubitril/valsartan (Sac/Val) is superior to angiotensin-converting enzyme inhibitors in reducing the risk of heart failure hospitalization and cardiovascular death, but its mechanistic data on myocardial scar after myocardial infarction (MI) are lacking. The objective of this work was to assess the effects of Sac/Val on inflammation, fibrosis, electrophysiological properties, and ventricular tachycardia inducibility in post-MI scar remodeling in swine. METHODS After MI, 22 pigs were randomized to receive β-blocker (BB; control, n=8) or BB+Sac/Val (Sac/Val, n=9). The systemic immune response was monitored. Cardiac magnetic resonance data were acquired at 2-day and 29-day post MI to assess ventricular remodeling. Programmed electrical stimulation and high-density mapping were performed at 30-day post MI to assess ventricular tachycardia inducibility. Myocardial samples were collected for histological analysis. RESULTS Compared with BB, BB+Sac/Val reduced acute circulating leukocytes (P=0.009) and interleukin-12 levels (P=0.024) at 2-day post MI, decreased C-C chemokine receptor type 2 expression in monocytes (P=0.047) at 15-day post MI, and reduced scar mass (P=0.046) and border zone mass (P=0.043). It also lowered the number and mass of border zone corridors (P=0.009 and P=0.026, respectively), scar collagen I content (P=0.049), and collagen I/III ratio (P=0.040). Sac/Val reduced ventricular tachycardia inducibility (P=0.034) and the number of deceleration zones (P=0.016). CONCLUSIONS After MI, compared with BB, BB+Sac/Val was associated with reduced acute systemic inflammatory markers, reduced total scar and border zone mass on late gadolinium-enhanced magnetic resonance imaging, and lower ventricular tachycardia inducibility.
Collapse
Affiliation(s)
- Daina Martínez-Falguera
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Faculty of Medicine, University of Barcelona, Spain (D.M.-F.)
| | - Júlia Aranyó
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- Department of Medicine, Autonomous University of Barcelona, Spain (J.A., A.B.-G.)
| | - Albert Teis
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Gemma Ferrer-Curriu
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
| | - Marta Monguió-Tortajada
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Department of Immunobiology, University of Lausanne, Epalinges, Vaud, Switzerland (M.M.-T.)
| | - Edgar Fadeuilhe
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Oriol Rodríguez-Leor
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Idoia Díaz-Güemes
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
| | - Santiago Roura
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
- Faculty of Medicine, University of Vic-Central University of Catalonia, Barcelona, Spain (S.R.)
| | - Roger Villuendas
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Axel Sarrias
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Victor Bazan
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Victoria Delgado
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- Department of Medicine, Autonomous University of Barcelona, Spain (J.A., A.B.-G.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Felipe Bisbal
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Carolina Gálvez-Montón
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| |
Collapse
|
2
|
Yin H, Ma L, Zhou Y, Tang X, Li R, Zhou Y, Shi J, Zhang J. Efficacy of early administration of sacubitril/valsartan after coronary artery revascularization in patients with acute myocardial infarction complicated by moderate-to-severe mitral regurgitation: a randomized controlled trial. Heart Vessels 2024:10.1007/s00380-024-02398-2. [PMID: 38635062 DOI: 10.1007/s00380-024-02398-2] [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: 10/22/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Effects of angiotensin receptor/neprilysin inhibitors (ARNI) on ventricular remodeling in patients with heart failure, especially heart failure with reduced ejection fraction (HFrEF), are better than those of angiotensin-converting enzyme inhibitors (ACEI). Acute myocardial infarction (AMI) complicated by mitral regurgitation exacerbates ventricular remodeling and increases the risk of heart failure. There is limited evidence on the effects of early administration of ARNI in patients with AMI complicated by mitral regurgitation. The aim of this trial was to examine the effectiveness and the safety of early administration of sacubitril/valsartan after coronary artery revascularization in patients with AMI complicated by moderate-to-severe mitral regurgitation. This was a randomized, single-blind, parallel-group, controlled trial. From June 2021 to June 2022, we enrolled 142 consecutive patients with AMI complicated by moderate-to-severe mitral regurgitation and followed them for 12 months. The patients received standard treatment for AMI and were randomly assigned to receive ARNI or benazepril. The primary efficacy end points were the differences in mitral regurgitant jet area (MRJA), mitral regurgitant volume (MRV), concentration of n-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume and end-systolic volume (LVEDV and LVESV) between groups and within groups at baseline, 1, 3, 6, and 12 months. Secondary end points included the rates of heart failure hospitalization, all-cause mortality, refractory angina, malignant arrhythmias, recurrent myocardial infarction, and stroke. Safety end points included the rates of hyperkalemia, renal dysfunction, hypotension, angioedema, and cough. The ARNI group had significantly lower NT-proBNP levels than the benazepril group at 1 month and later (P < 0.001). MRJA and MRV significantly improved in the ARNI group compared with the benazepril group at 12 months (MRJA: - 3.21 ± 2.18 cm2 vs. - 1.83 ± 2.81 cm2, P < 0.05; MRV: - 27.22 ± 15.22 mL vs. - 13.67 ± 21.02 mL, P < 0.001). The ARNI group also showed significant reductions in LVEDV and LVESV (P < 0.05) and improvement in LVEF (P < 0.05). Secondary end point analysis showed a significantly higher rate of heart failure hospitalization in the benazepril group compared with the ARNI group (HR = 2.03, 95% CI 1.12-3.68, P = 0.021). Safety end point analysis showed a higher rate of hypotension in the ARNI group (P < 0.05). Early use of sacubitril/valsartan after coronary artery revascularization in patients with AMI complicated by moderate-to-severe mitral regurgitation can significantly reduce mitral regurgitation, improve ventricular remodeling, and decrease heart failure hospitalization. Nevertheless, caution is needed to avoid hypotension. Chinese Clinical Trial Registry (ChiCTR2100054255) registered on December 11, 2021.
Collapse
Affiliation(s)
- Hongtao Yin
- Tianjin Medical University, Tianjin, 300000, People's Republic of China
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Lixiang Ma
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Yanqing Zhou
- The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Xiuying Tang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Runjun Li
- Department of Critical Care Medicine, People's Hospital of Yangjiang, Yangjiang, Guangdong, 529500, People's Republic of China
| | - Yingjun Zhou
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Jiaxiu Shi
- The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Jun Zhang
- Tianjin Medical University, Tianjin, 300000, People's Republic of China.
- Depatment of Cardiology, Cangzhou Central Hospital, Tianjin Medical University Teaching Hospital, Cangzhou, Hebei, 061000, People's Republic of China.
| |
Collapse
|
3
|
Mann DL, Nicolas J, Claggett B, Miao ZM, Granger CB, Kerkar P, Køber L, Lewis EF, McMurray JJV, Maggioni AP, Núñez J, Ntsekhe M, Rouleau JL, Sim D, Solomon SD, Steg PG, van der Meer P, Braunwald E, Pfeffer MA, Mehran R. Angiotensin Receptor-Neprilysin Inhibition in Patients With STEMI vs NSTEMI. J Am Coll Cardiol 2024; 83:904-914. [PMID: 38418004 DOI: 10.1016/j.jacc.2024.01.002] [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: 10/16/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Patients who sustain an acute myocardial infarction (AMI), including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), remain at high risk for heart failure (HF), coronary events, and death. Angiotensin-converting enzyme inhibitors have been shown to significantly decrease the risk for cardiovascular events in both STEMI and NSTEMI patients. OBJECTIVES The objectives were to determine whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril/valsartan, compared with ramipril, has impact on reducing cardiovascular events according to the type of AMI. METHODS The PARADISE-MI (Prospective ARNI versus ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction) trial enrolled patients with AMI complicated by left ventricular dysfunction and/or pulmonary congestion and at least 1 risk-enhancing factor. Patients were randomized to either sacubitril/valsartan or ramipril. The primary endpoint was death from cardiovascular causes or incident HF. In this prespecified analysis, we stratified patients according to AMI type. RESULTS Of 5,661 enrolled patients, 4,291 (75.8%) had STEMI. These patients were younger and had fewer comorbidities and cardiovascular risk factors than NSTEMI patients. After adjustment for potential confounders, the risk for the primary outcome was marginally higher in NSTEMI vs STEMI patients (adjusted HR: 1.19; 95% CI: 1.00-1.41), with borderline statistical significance (P = 0.05). The primary composite outcome occurred at similar rates in patients randomized to sacubitril/valsartan vs ramipril in STEMI (10% vs 12%; HR: 0.87; 95% CI: 0.73-1.04; P = 0.13) and NSTEMI patients (17% vs 17%; HR: 0.97; 95% CI: 0.75-1.25; P = 0.80; P interaction = 0.53). CONCLUSIONS Compared with ramipril, sacubitril/valsartan did not significantly decrease the risk for cardiovascular death and HF in patients with AMI complicated by left ventricular dysfunction, irrespective of the type of AMI. (Prospective ARNI vs ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI; NCT02924727).
Collapse
Affiliation(s)
- Douglas L Mann
- Washington University School of Medicine, St Louis, Missouri, USA.
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Prafulla Kerkar
- Department of Cardiology, KEM Hospital, Mumbai, Maharashtra, India
| | - Lars Køber
- Rigshospitalet, Blegdamsvej, Copenhagen, Denmark
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, California, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | | | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | | | - David Sim
- National Heart Center Singapore, Singapore, Singapore
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe Gabriel Steg
- Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, INSERM_U1148, Paris, France
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
4
|
Udell JA, Armstrong DWJ. Targeting the Natriuretic Peptide System to Improve Outcomes: PARADISE Lost or Found. J Am Coll Cardiol 2024; 83:915-917. [PMID: 38418005 DOI: 10.1016/j.jacc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Jacob A Udell
- Women's College Hospital and Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - David W J Armstrong
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
5
|
Akhtar KH, Khan MS, Baron SJ, Zieroth S, Estep J, Burkhoff D, Butler J, Fudim M. The spectrum of post-myocardial infarction care: From acute ischemia to heart failure. Prog Cardiovasc Dis 2024; 82:15-25. [PMID: 38242191 DOI: 10.1016/j.pcad.2024.01.017] [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: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
Heart failure (HF) is the leading cause of mortality in patients with acute myocardial infarction (AMI), with incidence ranging from 14% to 36% in patients admitted due to AMI. HF post-MI develops due to complex inter-play between macrovascular obstruction, microvascular dysfunction, myocardial stunning and remodeling, inflammation, and neuro-hormonal activation. Cardiogenic shock is an extreme presentation of HF post-MI and is associated with a high mortality. Early revascularization is the only therapy shown to improve survival in patients with cardiogenic shock. Treatment of HF post-MI requires prompt recognition and timely introduction of guideline-directed therapies to improve mortality and morbidity. This article aims to provide an up-to-date review on the incidence and pathogenesis of HF post-MI, current strategies to prevent and treat onset of HF post-MI, promising therapeutic strategies, and knowledge gaps in the field.
Collapse
Affiliation(s)
- Khawaja Hassan Akhtar
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Suzanne J Baron
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerry Estep
- Section of Heart Failure & Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, Columbia University Medical Center, New York City, NY, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
| |
Collapse
|
6
|
van de Veerdonk MC, Savarese G, Handoko ML, Beulens JWJ, Asselbergs F, Uijl A. Multimorbidity in Heart Failure: Leveraging Cluster Analysis to Guide Tailored Treatment Strategies. Curr Heart Fail Rep 2023; 20:461-470. [PMID: 37658971 PMCID: PMC10589138 DOI: 10.1007/s11897-023-00626-w] [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: 08/16/2023] [Indexed: 09/05/2023]
Abstract
REVIEW PURPOSE This review summarises key findings on treatment effects within phenotypical clusters of patients with heart failure (HF), making a distinction between patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). FINDINGS Treatment response differed among clusters; ACE inhibitors were beneficial in all HFrEF phenotypes, while only some studies show similar beneficial prognostic effects in HFpEF patients. Beta-blockers had favourable effects in all HFrEF patients but not in HFpEF phenotypes and tended to worsen prognosis in older, cardiorenal patients. Mineralocorticoid receptor antagonists had more favourable prognostic effects in young, obese males and metabolic HFpEF patients. While a phenotype-guided approach is a promising solution for individualised treatment strategies, there are several aspects that still require improvements before such an approach could be implemented in clinical practice. Stronger evidence from clinical trials and real-world data may assist in establishing a phenotype-guided treatment approach for patient with HF in the future.
Collapse
Affiliation(s)
- Mariëlle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Folkert Asselbergs
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Health Data Research UK London, Institute for Health Informatics, University College London, London, UK
| | - Alicia Uijl
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
7
|
Myhre PL, Liu Y, Kulac IJ, Claggett BL, Prescott MF, Felker GM, Butler J, Piña IL, Rouleau JL, Zile MR, McMurray JJV, Ward JH, Solomon SD, Januzzi JL. Changes in mid-regional pro-adrenomedullin during treatment with sacubitril/valsartan. Eur J Heart Fail 2023; 25:1396-1405. [PMID: 37401523 DOI: 10.1002/ejhf.2957] [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: 03/22/2023] [Revised: 05/26/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
AIMS Adrenomedullin is a vasodilatory peptide with a role in microcirculatory and endothelial homeostasis. Adrenomedullin is a substrate for neprilysin and may therefore play a role in beneficial effects of sacubitril/valsartan (Sac/Val) treatment. METHODS AND RESULTS Mid-regional pro-adrenomedullin (MR-proADM) was measured in 156 patients with heart failure with reduced ejection fraction (HFrEF) treated with Sac/Val and 264 patients with heart failure with preserved ejection fraction (HFpEF) randomized to treatment with Sac/Val or valsartan. Echocardiography and Kansas City Cardiomyopathy Questionnaire results were collected at baseline and after 6 and 12 months in the HFrEF cohort. Median (Q1-Q3) baseline MR-proADM concentrations were 0.80 (0.59-0.99) nmol/L in HFrEF and 0.88 (0.68-1.20) nmol/L in HFpEF. After 12 weeks of treatment with Sac/Val, MR-proADM increased by median 49% in HFrEF and 60% in HFpEF, while there were no significant changes in valsartan-treated patients (median 2%). Greater increases in MR-proADM were associated with higher Sac/Val doses. Changes in MR-proADM correlated weakly with changes in N-terminal pro-B-type natriuretic peptide, cardiac troponin T and urinary cyclic guanosine monophosphate. Increases in MR-proADM were associated with decreases in blood pressure, but not significantly associated with changes in echocardiographic parameters or health status. CONCLUSIONS MR-proAD concentrations rise substantially following treatment with Sac/Val, in contrast to no change from valsartan. Change in MR-proADM from neprilysin inhibition did not correlate with improvements in cardiac structure and function or health status. More data are needed regarding the role of adrenomedullin and its related peptides in the treatment of heart failure. CLINICAL TRIAL REGISTRATION PROVE-HF ClinicalTrials.gov Identifier: NCT02887183, PARAMOUNT ClinicalTrials.gov Identifier: NCT00887588.
Collapse
Affiliation(s)
- Peder L Myhre
- Division of Medicine, Akershus University Hospital and K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Yuxi Liu
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ian J Kulac
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | - G Michael Felker
- Duke University Medical School and Duke Clinical Research Institute, Durham, NC, USA
| | - Javed Butler
- University of Mississippi Medical School, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Jean L Rouleau
- Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | | | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Baim Institute for Clinical Research, Boston, MA, USA
| |
Collapse
|
8
|
Tao W, Yang X, Zhang Q, Bi S, Yao Z. Optimal treatment for post-MI heart failure in rats: dapagliflozin first, adding sacubitril-valsartan 2 weeks later. Front Cardiovasc Med 2023; 10:1181473. [PMID: 37383701 PMCID: PMC10296765 DOI: 10.3389/fcvm.2023.1181473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 06/30/2023] Open
Abstract
Background Based on previous research, both dapagliflozin (DAPA) and sacubitril-valsartan (S/V) improve the prognosis of patients with heart failure (HF). Our study aims to investigate whether the early initiation of DAPA or the combination of DAPA with S/V in different orders would exert a greater protective effect on heart function than that of S/V alone in post-myocardial infarction HF (post-MI HF). Methods Rats were randomized into six groups: (A) Sham; (B) MI; (C) MI + S/V (1st d); (D) MI + DAPA (1st d); (E) MI + S/V (1st d) + DAPA (14th d); (F) MI + DAPA (1st d) + S/V (14th d). The MI model was established in rats via surgical ligation of the left anterior descending coronary artery. Histology, Western blotting, RNA-seq, and other approaches were used to explore the optimal treatment to preserve the heart function in post-MI HF. A daily dose of 1 mg/kg DAPA and 68 mg/kg S/V was administered. Results The results of our study revealed that DAPA or S/V substantially improved the cardiac structure and function. DAPA and S/V monotherapy resulted in comparable reduction in infarct size, fibrosis, myocardium hypertrophy, and apoptosis. The administration of DAPA followed by S/V results in a superior improvement in heart function in rats with post-MI HF than those in other treatment groups. The administration of DAPA following S/V did not result in any additional improvement in heart function as compared to S/V monotherapy in rats with post-MI HF. Our findings further suggest that the combination of DAPA and S/V should not be administered within 3 days after acute myocardial infarction (AMI), as it resulted in a considerable increase in mortality. Our RNA-Seq data revealed that DAPA treatment after AMI altered the expression of genes related to myocardial mitochondrial biogenesis and oxidative phosphorylation. Conclusions Our study revealed no notable difference in the cardioprotective effects of singular DAPA or S/V in rats with post-MI HF. Based on our preclinical investigation, the most effective treatment strategy for post-MI HF is the administration of DAPA during the 2 weeks, followed by the addition of S/V to DAPA later. Conversely, adopting a therapeutic scheme whereby S/V was administered first, followed by later addition of DAPA, failed to further improve the cardiac function compared to S/V monotherapy.
Collapse
Affiliation(s)
- Wenqi Tao
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
| | - Xiaoyu Yang
- Department of Cardiology, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Qing Zhang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuli Bi
- School of Medicine, Nankai University, Tianjin, China
| | - Zhuhua Yao
- Tianjin Union Medical Center, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| |
Collapse
|