Effects of sacubitril/valsartan on the arterial stiffness and left ventricular-arterial coupling in patients with heart failure with reduced ejection fraction

Abstract

Sacubitryl/valsartan in patients with heart failure with reduced ejection fraction (HFrEF) has shown an advantage over enalapril in reducing the risk of cardiovascular mortality and hospitalizations due to heart failure. Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC) and arterial stiffness in HFrEF patients. Material and methods. Arterial stiffness by applanation tonometry and LVAC - by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69±9 years, 89% male, arterial hypertension - 83%, diabetes - 39%, myocardial infarction - 89%, left ventricular ejection fraction 32±4%) initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance)/ Ees (left ventricular elastance) ratio. Differences were considered statistically significant at p < 0.05. Results. 72% of patients initially had elevated pulse wave velocity (PWV > 10 m/s). The decrease in PWV (from 11.5±2.9 to 10.2±2.9 m/s, p < 0.05), of the augmentation pressure (from 15.3±8.9 to 10.5±5.0 mm Hg, p=0.002), the increase in the reflected wave transit time (from 132±9 to 143±29 ms, p=0.02) and the subendocardial viability ratio (from 164±25 to 177±37%; p=0.009) were found after 12 months. Sacubitryl/valsartan- based therapy was associated with a decrease in central systolic blood pressure (from 116±19 to 106±10 mm Hg; p=0.001) and central pulse blood pressure (from 44±15 to 38±7 mm Hg; p < 0.05). Decrease in Ea (from 2.20±0.84 to 1.79±0.63 mm Hg/ml/m2; p=0.005) and Ea/Ees ratio (from 2.26±0.77 to 1.68±0.32; p=0.05) was found after 12 months. Ees did not change statistically significantly (1.00±0.34 vs 1.01±0.44 mm Hg/ml/m2). The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found. Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave.