PMID- 31636797
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220410
IS  - 1923-2829 (Print)
IS  - 1923-2837 (Electronic)
IS  - 1923-2829 (Linking)
VI  - 10
IP  - 5
DP  - 2019 Oct
TI  - Sacubitril/Valsartan Therapy for 14 Months Induces a Marked Improvement of Global 
      Longitudinal Strain in Patients With Chronic Heart Failure: A Retrospective 
      Cohort Study.
PG  - 293-302
LID - 10.14740/cr910 [doi]
AB  - BACKGROUND: Clinical efficacy of sacubitril/valsartan administered for the 
      recommended indication of chronic heart failure (CHF) patients with New York 
      Heart Association (NYHA) classes II-III appears to be higher than one would 
      expect based on the drug-induced variations of the left ventricular ejection 
      fraction (LVEF). More thorough investigations with the use of indicators of 
      longitudinal systolic function have been therefore recommended to verify whether 
      a part of the clinical improvement achieved with the use of sacubitril/valsartan 
      could be supported by a reverse remodeling ensuing from changes other than a 
      simple LVEF increase. METHODS: In the present retrospective cohort study, which 
      collected the pertinent data from two centers devoted to clinical management of 
      outpatients with CHF and dating back to the years 2017 and 2018, we separated 
      patients treated with sacubitril/valsartan from those treated with conventional 
      medical therapy, including angiotensin-converting enzyme (ACE) inhibitors or 
      angiotensin-receptor blockers (ARBs). For the rest, the therapies practiced in 
      the two groups, patients under sacubitril/valsartan and controls, were almost 
      identical, including similar doses of beta-blockers and mineralocorticoid 
      receptor antagonists (MRAs) in the two cohorts, plus loop diuretics, with the 
      latter administered at variable doses. The endpoints were the variations of LVEF 
      and global left ventricular longitudinal strain (GLS) over a study period not 
      shorter than 1 year. RESULTS: One hundred thirty-two patients were collected 
      within our retrospective cohort study, of whom 44 were treated with 
      sacubitril/valsartan and 88 were subjected to conventional therapy. All patients 
      were marked by heart failure with reduced (LVEF </= 40%) left ventricular ejection 
      fraction (HFREF). The mean duration of the retrospective observation period was 
      14 +/- 3 months. In controls, LVEF was improved after a year of therapy from 38.071 
      +/- 5.445% (mean +/- standard deviation) to 41.595 +/- 5.282%. On the contrary, no 
      significant improvement in the controls could be identified for the GLS, from 
      -12.059 +/- 4.016% to -12.250 +/- 4.287%. In analogy with controls, patients assigned 
      to sacubitril/valsartan showed a significant increase in LVEF after 1 year of 
      treatment from 39.714 +/- 4.789% to 42.119 +/- 5.683% (P < 0.001). However, 
      differently from the controls, sacubitril/valsartan group exhibited a significant 
      improvement in GLS from -10.142 +/- 3.080% to -18.238 +/- 7.284% (P < 0.001). 
      CONCLUSIONS: The present retrospective cohort study demonstrated that the use of 
      sacubitril/valsartan for HFREF patients, extended for a mean duration of 14 
      months, yields a significant improvement in the echocardiographic parameters of 
      systolic function along the transverse (LVEF) and longitudinal (GLS) axis. For 
      the GLS in particular, a clear superiority emerges in comparison with 
      conventional therapy including ACE inhibitor or ARBs. From these data, the 
      hypothesis could be derived of a possible useful role of sacubitril/valsartan 
      also for the therapy of HFpEF. In this regard, more exhaustive clarifications 
      ensuing from the ongoing randomized controlled trials (RCTs) are eagerly awaited.
CI  - Copyright 2019, De Vecchis et al.
FAU - De Vecchis, Renato
AU  - De Vecchis R
AD  - Preventive Cardiology and Rehabilitation Unit, DSB 29 "S. Gennaro dei Poveri 
      Hospital", via S.Gennaro dei Poveri 25, 80136 Naples, Italy.
FAU - Paccone, Andrea
AU  - Paccone A
AD  - Department of Cardiology, University of Bari "Aldo Moro", Bari, Italy.
FAU - Di Maio, Marco
AU  - Di Maio M
AD  - Department of Cardiology, University of Campania "Luigi Vanvitelli", 80138 
      Naples, Italy.
LA  - eng
PT  - Journal Article
DEP - 20191004
PL  - Canada
TA  - Cardiol Res
JT  - Cardiology research
JID - 101557543
PMC - PMC6785293
OTO - NOTNLM
OT  - Clinical outcomes
OT  - Global longitudinal strain
OT  - Sacubitril/valsartan
COIS- The authors Renato De Vecchis, Andrea Paccone and Marco Di Maio do not have any 
      conflict of interest to declare concerning the present article.
EDAT- 2019/10/23 06:00
MHDA- 2019/10/23 06:01
PMCR- 2019/10/01
CRDT- 2019/10/23 06:00
PHST- 2019/07/12 00:00 [received]
PHST- 2019/08/16 00:00 [accepted]
PHST- 2019/10/23 06:00 [entrez]
PHST- 2019/10/23 06:00 [pubmed]
PHST- 2019/10/23 06:01 [medline]
PHST- 2019/10/01 00:00 [pmc-release]
AID - 10.14740/cr910 [doi]
PST - ppublish
SO  - Cardiol Res. 2019 Oct;10(5):293-302. doi: 10.14740/cr910. Epub 2019 Oct 4.