Sacubitril-Valsartan Does Not Impact Aortic Stiffness in HFrEF

For patients with heart failure and reduced ejection fraction (HFrEF), sacubitril-valsartan does not impact aortic stiffness versus enalapril but is associated with improvements in cardiac structure and function, according to two studies published online in the Journal of the American Medical Association.

Akshay S. Desai, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues randomly assigned patients with HFrEF to either sacubitril-valsartan (231 patients) or enalapril (233 patients) for 12 weeks. The researchers found that aortic characteristic impedance decreased at 12 weeks with sacubitril-valsartan and increased with enalapril; there was no statistically significant change from baseline between the groups. No significant between-group differences were seen in the change from baseline for four specified secondary end points, including left ventricular ejection fraction (LVEF). Significant reductions from baseline were seen in left atrial volume index (LAVI), LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESDI), and mitral ratio of early transmitral Doppler velocity/early diastolic annular velocity (E/e') with sacubitril-valsartan.

James L. Januzzi Jr., M.D., from Massachusetts General Hospital in Boston, and colleagues conducted a prospective study involving 654 patients with HFrEF treated with sacubitril-valsartan. The researchers found that the change in log2-N terminal pro-b-type natriuretic peptide concentration was associated with changes in LVEF, LVEDVI, LVESVI, LAVI, and E/e' ratio. LVEF increased from 28.2 to 37.8 percent at 12 months; significant decreases were seen in LVEDVI and in LVESVI.

"These trials suggest that sacubitril/valsartan may actually reverse the cardiac remodeling that drives heart failure progression and worsening of clinical outcomes," Desai said in a statement.

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