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.