Arq. Bras. Cardiol. 2020; 115(5): 821-827
Maximal Oxygen Uptake and Ventilation Improvement Following Sacubitril-Valsartan Therapy
António Valentim Gonçalves
, Tiago Pereira-da-Silva, Ana Galrinho, Pedro Rio, Rui Soares, Joana Feliciano, Rita Ilhão Moreira, Sofia Silva, Sandra Alves, Eunice Capilé, Rui Cruz Ferreira
This Original Article is referred by the Short Editorial "Angiotensin Receptor-Neprilysin Inhibition Therapy and Improved Exercise Parameters in Heart Failure with Reduced Ejection Fraction".
Abstract
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. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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