PMID- 29771478
OWN - NLM
STAT- MEDLINE
DCOM- 20181029
LR  - 20211204
IS  - 1755-5922 (Electronic)
IS  - 1755-5914 (Linking)
VI  - 36
IP  - 4
DP  - 2018 Aug
TI  - The reverse remodeling response to sacubitril/valsartan therapy in heart failure 
      with reduced ejection fraction.
PG  - e12435
LID - 10.1111/1755-5922.12435 [doi]
AB  - BACKGROUND: Major classes of medical therapy for heart failure with reduced 
      ejection fraction (HFrEF) induce reverse remodeling. The revere remodeling 
      response to sacubitril/valsartan remains unstudied. METHODS: We performed a 
      single-center, prospective assessor-blinded study to determine the reverse 
      remodeling response of sacubitril/valsartan therapy in HFrEF patients with a 
      class I indication (New York heart Association [NYHA]-class II-IV, Left 
      ventricular ejection fraction [LVEF] < 35%, optimal dose with 
      Renin-Angiotensin-System-Blocker [RAS-blocker]). Doses of sacubitril/valsartan 
      were optimized to individual tolerance. Echocardiographic images were assessed 
      offline by 2 investigators blinded to both the clinical data and timing of 
      echocardiograms. RESULTS: One-hundred-twenty-five HFrEF patients (66 +/- 10 years) 
      were prospectively included. The amount of RAS-blocker before and after switch to 
      sacubitril/valsartan was similar(P = .290), indicating individual optimal dosing 
      of sacubitril/valsartan. Over a median(IQR) follow-up of 118(77-160) days after 
      initiation of sacubitril/valsartan, LVEF improved (29.6 +/- 6% vs 34.8 +/- 6%; 
      P < .001) and Left ventricular end-systolic (LVESV) and end-diastolic volume 
      (LVEDV) decreased (LVESV; 147 +/- 57 mL vs 129 +/- 55 mL; P < .001 and LVEDV; 
      206 +/- 71 mL vs197 +/- 72 mL; P = .027). Volumetric remodeling was associated with a 
      reduction in the degree of mitral regurgitation (1.59 +/- 1.0 vs 1.11 +/- 0.8; 
      P < .001; [scale from 0-4]). Metrics of diastolic function improved; including a 
      drop in the E/A-wave ratio (1.75 +/- 1.13 vs 1.38 +/- 0.88; P = .002) and diastolic 
      filling time (% of cycle length) prolonged (48 +/- 9% vs 52 +/- 1%; P = .005). The 
      percent of patients with a restrictive mitral filling pattern dropped from 47% to 
      23% (P = .004). A dose-dependent effect was noted for changes in LVEF (P < .001) 
      and LVESV (P = .031), with higher doses of sacubitril/valsartan leading to more 
      reverse remodeling. CONCLUSION: Switching therapy in eligible HFrEF patients from 
      a RAS-blocker to sacubitril/valsartan induces beneficial reverse remodeling of 
      both metrics of systolic as diastolic function.
CI  - (c) 2018 John Wiley & Sons Ltd.
FAU - Martens, Pieter
AU  - Martens P
AUID- ORCID: 0000-0002-6036-2113
AD  - Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
AD  - Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, 
      Belgium.
FAU - Belien, Hanne
AU  - Belien H
AD  - Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
FAU - Dupont, Matthias
AU  - Dupont M
AD  - Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
FAU - Vandervoort, Pieter
AU  - Vandervoort P
AD  - Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
AD  - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt 
      University, Diepenbeek, Belgium.
FAU - Mullens, Wilfried
AU  - Mullens W
AD  - Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
AD  - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt 
      University, Diepenbeek, Belgium.
LA  - eng
PT  - Journal Article
DEP - 20180607
PL  - England
TA  - Cardiovasc Ther
JT  - Cardiovascular therapeutics
JID - 101319630
RN  - 0 (Aminobutyrates)
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Angiotensin II Type 2 Receptor Blockers)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Drug Combinations)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
SB  - IM
MH  - Aged
MH  - Aminobutyrates/adverse effects/*therapeutic use
MH  - Angiotensin II Type 1 Receptor Blockers/adverse effects/*therapeutic use
MH  - Angiotensin II Type 2 Receptor Blockers/adverse effects/*therapeutic use
MH  - Belgium
MH  - Biphenyl Compounds
MH  - Dose-Response Relationship, Drug
MH  - Drug Combinations
MH  - Echocardiography, Doppler
MH  - Female
MH  - Heart Failure/diagnosis/*drug therapy/physiopathology
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Recovery of Function
MH  - Stroke Volume/*drug effects
MH  - Tetrazoles/adverse effects/*therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - Valsartan
MH  - Ventricular Function, Left/*drug effects
MH  - Ventricular Remodeling/*drug effects
OTO - NOTNLM
OT  - echocardiography
OT  - heart failure
OT  - left ventricular ejection fraction
OT  - reverse remodeling
OT  - sacubitril/valsartan
EDAT- 2018/05/18 06:00
MHDA- 2018/10/30 06:00
CRDT- 2018/05/18 06:00
PHST- 2018/04/12 00:00 [received]
PHST- 2018/05/04 00:00 [revised]
PHST- 2018/05/09 00:00 [accepted]
PHST- 2018/05/18 06:00 [pubmed]
PHST- 2018/10/30 06:00 [medline]
PHST- 2018/05/18 06:00 [entrez]
AID - 10.1111/1755-5922.12435 [doi]
PST - ppublish
SO  - Cardiovasc Ther. 2018 Aug;36(4):e12435. doi: 10.1111/1755-5922.12435. Epub 2018 
      Jun 7.