Sacubitril/valsartan useful in heart failure with reduced ejection fraction

Treatment with sacubitril/valsartan appears to improve right ventricular performance and pulmonary hypertension among patients with heart failure with reduced ejection fraction (HFrEF), independent of the reverse remodelling of the left ventricle, as reported in a study.

Researchers performed a systematic review and meta-analysis of studies reporting right ventricular and pulmonary pressure indexes following sacubitril/valsartan treatment. They searched multiple online databases and identified 3,670 publications, out of which 10 were included in the meta-analysis.

A total of 875 patients comprised the population (mean age 62.2 years, 74.0 percent men). All patients had HF with ejection fractions of ≤40 percent. The mean follow‐up duration ranged 3–17.1 months. Of the studies, six were prospective and four were retrospective. These studies were conducted in Italy, Turkey, France, Greece, and Slovenia.

Pooled data revealed significant improvements in right ventricular function and pulmonary hypertension after sacubitril/valsartan initiation. Specifically, there were favourable effects noted in tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm, 95 percent confidence interval [CI], 0.33–2.18; p=0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s, 95 percent CI, 0.25–1.45; p=0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg, 95 percent CI, 5.38–9.03; p<0.001).

In addition, sacubitril/valsartan exerted a beneficial effect on left heart function, which was consistent with previous studies. The quadratic regression model showed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction following exclusion of inappropriate data (p=0.026).