Maximal Oxygen Uptake and Ventilation Improvement Following Sacubitril-Valsartan Therapy

• Autor(a) principal: Valentim Gonçalves, A
• Data de Publicação: 2020
• Outros Autores: Pereira-da-Silva, T, Galrinho, A, Rio, P, Soares, RM, Feliciano, J, Ilhão Moreira, R, Silva, S, Alves, S, Capilé, E, Cruz Ferreira, R
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/3533
• topic: HSM CAR; Aminobutyrates; Aged; Angiotensin Receptor Antagonists; Drug Combinations; Heart Failure / drug therapy; Humans; Middle Aged; Prospective Studies; Oxygen; Stroke Volume; Tetrazoles; Treatment Outcome; Ventricular Function, Left

Background: Sacubitril/valsartan had its prognosis benefit confirmed in the PARADIGM-HF trial. However, data on cardiopulmonary exercise testing (CPET) changes with sacubitril-valsartan therapy are scarce. Objective: This study aimed to compare CPET parameters before and after sacubitril-valsartan therapy. Methods: Prospective evaluation of chronic heart failure (HF) patients with left ventricular ejection fraction ≤40% despite optimized standard of care therapy, who started sacubitril-valsartan therapy, expecting no additional HF treatment. CPET data were gathered in the week before and 6 months after sacubitril-valsartan therapy. Statistical differences with a p-value <0.05 were considered significant. Results: Out of 42 patients, 35 (83.3%) completed the 6-month follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years. New York Heart Association class improved in 26 (74.3%) patients. Maximal oxygen uptake (VO2max) (14.4 vs. 18.3 ml/kg/min, p<0.001), VE/VCO2slope (36.7 vs. 31.1, p<0.001), and exercise duration (487.8 vs. 640.3 sec, p<0.001) also improved with sacubitril-valsartan. Benefit was maintained even with the 24/26 mg dose (13.5 vs. 19.2 ml/kg/min, p=0.018) of sacubitril-valsartan, as long as this was the highest tolerated dose. Conclusions: Sacubitril-valsartan therapy is associated with marked CPET improvement in VO2max, VE/VCO2slope, and exercise duration.