Effects of sacubitril/valsartan on pulmonary hypertension in heart failure patients with preserved ejection fraction

Janine Brockmöller (Bad Bevensen)1, S. M. Müller (Bad Bevensen)1, M. A. Januszewski (Bad Bevensen)1, B. A. Remppis (Bad Bevensen)1, C. Burgdorf (Bad Bevensen)1

1Herz- und Gefäßzentrum Bad Bevensen Klinik für Kardiologie Bad Bevensen, Deutschland


Objectives: Patients with heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension have a poor survival, while established medical therapies concomitantly adressing both entities are not available. 
Methods: In this retrospective study of 51 patients with HFpEF, we investigated the effects of sacubitril/valsartan on combined postcapillary and precapillary pulmonary hypertension (according to current criteria of the European Society of Cardiology) measured by right heart catheterization (RHC) at baseline (i.e., pre-sacubitril/valsartan) and 101 (95 - 160) days after switching to sacubitril/valsartan. Results are given as median and interquartile range.
Results: After switching to sacubitril/valsartan, RHC showed significantly lower pulmonary artery pressures (PAP) (systolic/diastolic/mean), mean pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVR) compared to pre-sacubitril/valsartan (PA: 49 [38 - 56]/17 [14 - 23]/32 [26 - 36] mm Hg versus 55 [50 - 66]/23 [18 - 27]/35 [32 - 43] mm Hg; PCWP: 18 [13 - 25] mm Hg versus 22 [18 - 27] mm Hg; PVR: 2.3 [1.6 - 3.1] Wood units versus 3.0 [2.6 – 3.5] Wood units; each p < 0.01). The median sacubitril/valsartan dose at follow-up was 24/26 (24/26 - 49/51) mg twice daily. Clinically, the New York Heart Association functional class improved by at least one class in 17 of the 51 patients (p < 0.01).
Conclusion: Sacubitril/valsartan therapy improves pulmonary hypertension in patients with HFpEF and combined postcapillary and precapillary pulmonary hypertension even with the lowest dosage available. Uptitration of sacubitril/valsartan according to the guidelines might thus have even greater effects and open the avenue to a therapy of an otherwise highly morbid and mortal pathophysiological condition.
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