PMID- 36440034
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221129
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 9
DP  - 2022
TI  - Effects of sacubitril/valsartan in ESRD patients undergoing hemodialysis with 
      HFpEF.
PG  - 955780
LID - 10.3389/fcvm.2022.955780 [doi]
LID - 955780
AB  - INTRODUCTION: Heart failure with preserved ejection fraction (HFpEF), which is a 
      common co-morbidity in patients with maintenance hemodialysis (MHD), results in 
      substantial mortality and morbidity. However, there are still no effective 
      therapeutic drugs available for HFpEF currently. Sacubitril/valsartan has been 
      shown to significantly improve clinical outcomes and reverse myocardial 
      remodeling among patients with heart failure with reduced ejection fraction 
      (HFrEF). The effect of sacubitril/valsartan in MHD patients with HFpEF remains 
      unclear. Our study was designed to assess the efficacy and safety of 
      sacubitril/valsartan in MHD patients with HFpEF. METHODS: A total of 247 MHD 
      patients with HFpEF treated with sacubitril/valsartan were included in this 
      retrospective study. Patients were followed up regularly after medication 
      treatment. The alterations in clinical, biochemical, and echocardiographic 
      parameters before and after taking sacubitril/valsartan were collected. In 
      addition, the safety of the sacubitril/valsartan treatment was also assessed. 
      Among those 247 patients with MHD, 211 patients were already in treatment with 
      angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers 
      (ARBs) before being treated with sacubitril/valsartan. We also performed an 
      analysis to compare the differences between the 211 patients who had previously 
      received ACEi/ARB treatment and the 36 patients who were sacubitril/valsartan 
      naive. RESULTS: Among those 247 patients with MHD, compared with baseline levels, 
      systolic blood pressure (BP) (149.7 +/- 23.6 vs. 137.2 +/- 21.0 mmHg, P < 0.001), 
      diastolic BP (90.2 +/- 16.1 vs. 84.5 +/- 14.1 mmHg, P < 0.001), heart rate (83.5 +/- 
      12.5 vs. 80.0 +/- 8.7 bpm, P < 0.001), N-terminal B-type natriuretic peptide 
      precursor (NT-proBNP) [29125.0 (11474.5, 68532.0) vs. 12561.3 (4035.0, 37575.0) 
      pg/ml, P < 0.001], and cardiac troponin I [0.044 (0.025, 0.078) vs. 0.0370 
      (0.020, 0.064) mug/L, P = 0.009] were markedly decreased after treatment with 
      sacubitril/valsartan. New York Heart Association (NYHA) functional class showed a 
      notable trend of improvement after 3-12 months of follow-up. Echocardiographic 
      parameters including left ventricular posterior wall thickness (LVPWT) (11.8 +/- 
      2.0 vs. 10.8 +/- 1.9 mm, P < 0.001), intraventricular septal thickness in diastole 
      (11.8 +/- 2.0 vs. 11.2 +/- 2.0 mm, P < 0.001), left ventricular end-diastolic 
      diameter (53.8 +/- 6.9 vs. 51.2 +/- 7.1 mm, P < 0.001), left atrial diameter (LAD) 
      (40.5 +/- 6.2 vs. 37.2 +/- 7.2 mm, P < 0.001), left ventricular end-diastolic volume 
      (LVEDV) [143.0 (111.5, 174.0) vs. 130.0 (105.0, 163.0) ml, P < 0.001], left 
      ventricular end-systolic volume (LVESV) [57.0 (43.0, 82.5) vs. 48.0 (38.0, 74.0) 
      ml, P < 0.001], and pulmonary arterial systolic pressure [39.0 (30.5, 50.0) vs. 
      28.0 (21.0, 37.5) mmHg, P < 0.001] were significantly reduced after initiating 
      the treatment of sacubitril/valsartan. The parameters of left ventricular 
      diastolic function including E/A ratio [0.8 (0.7, 1.3) vs. 0.9 (0.8, 1.3), P = 
      0.008], maximal tricuspid regurgitation velocity [2.7 (2.5, 3.2) vs. 2.4 (2.0, 
      2.8) m/s, P < 0.001], septal e'wave velocity (8.0 +/- 0.6 vs. 8.2 +/- 0.5 cm/s, P = 
      0.001), lateral e' wave velocity (9.9 +/- 0.8 vs. 10.2 +/- 0.7 cm/s, P < 0.001), E/e' 
      [8.3 (6.4, 11.8) vs. 7.2 (6.1, 8.9), P < 0.001], and left atrial volume index 
      (37.9 +/- 4.2 vs. 36.4 +/- 4.1 ml/m(2), P < 0.001) were significantly improved by 
      sacubitril/valsartan. Among 211 patients who were already in treatment with 
      ACEi/ARB and 36 patients who were sacubitril/valsartan naive, the improvement of 
      cardiac function demonstrated by clinical outcomes and echocardiographic 
      parameters were similar to the previous one of the 247 MHD patients with HFpEF. 
      During the follow-up, none of the patients showed severe adverse drug reactions. 
      CONCLUSION: Our study suggested that sacubitril/valsartan treatment in MHD 
      patients with HFpEF was effective and safe.
CI  - Copyright (c) 2022 Guo, Ren, Wang, Wang, Pu, Li, Yu, Wang, Liu and Tang.
FAU - Guo, Yanhong
AU  - Guo Y
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Ren, Mingjing
AU  - Ren M
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Wang, Tingting
AU  - Wang T
AD  - Department of Gastroenterology, Wenxian People's Hospital, Jiaozuo, China.
FAU - Wang, Yulin
AU  - Wang Y
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Pu, Tian
AU  - Pu T
AD  - Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou 
      University, Zhengzhou, China.
FAU - Li, Xiaodan
AU  - Li X
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Yu, Lu
AU  - Yu L
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Wang, Liuwei
AU  - Wang L
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
FAU - Liu, Peipei
AU  - Liu P
AD  - Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou 
      University, Zhengzhou, China.
FAU - Tang, Lin
AU  - Tang L
AD  - Department of Nephropathy, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, China.
LA  - eng
PT  - Journal Article
DEP - 20221109
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC9681904
OTO - NOTNLM
OT  - heart failure with preserved ejection fraction
OT  - hemodialysis
OT  - left ventricle dysfunction
OT  - pulmonary hypertension
OT  - sacubitril/valsartan
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/11/29 06:00
MHDA- 2022/11/29 06:01
PMCR- 2022/01/01
CRDT- 2022/11/28 04:48
PHST- 2022/05/29 00:00 [received]
PHST- 2022/10/17 00:00 [accepted]
PHST- 2022/11/28 04:48 [entrez]
PHST- 2022/11/29 06:00 [pubmed]
PHST- 2022/11/29 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2022.955780 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2022 Nov 9;9:955780. doi: 10.3389/fcvm.2022.955780. 
      eCollection 2022.