Effect of Sacubitril/Valsartan on left ventricular longitudinal strain in patients with hematologic malignancies after bone marrow transplantation

Abstract

Background and aims: Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with sacubitril valsartan could prevent cardiotoxicity. Patients and Methods: 40 patients (mean age 45,3+/-13,1 years old, 23 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation and were randomized to receive sacubitril/valsartan 24/26 mg bid daily or placebo. We measured at baseline, before transplantation, and after three months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) Left Ventricular Epicardial Strain (GLSepi), iii) Left Ventricular Endocardial Strain GLSendo), by speckle tracking imagind iv) Left Ventricular End Diastolic Volume, Left Ventricular End Systolic Volume and Left Ventricular Ejection Fraction (LVEF-Simpson's Method). Result(s): The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation. Compared to baseline, patients treated with sacubitril/valsartan did not show a deterioration of LV GLS and GLSepi [(GLS = -20,2+/-3,1% vs -19,8+/-3,1%, p=0,551), (GLSepi = -17,9+/-2,8% vs -17,8+/-3,1%, p=0,855), (GLSendo = -23,02+/-3,6% vs -22,6+/-3,5%, p=0,572)], Conversely, patients treated with placebo group, presented a significant impairment of LV GLS and GLSepi [(GLS = -20,5+/-1,9% vs 18,5+/-2,3%, p=0,006, GLSepi = -18,1+/-1,5% vs -16,1+/-2,1%, p=0,003), (GLSendo = -23,4+/-2,2% vs -21,4+/-2,6%, p=0,008)] six months after bone marrow transplantation. No significant changes were found in LVEF after treatment with sacubitril/valsartan (57,9+/-5,6% vs 57,6+/-6,1%, p=0,733) or the placebo (60,1+/-5,6% vs 57,8+/-6,6%, p=0,166). However, in the sacubitril valsartan group, we noticed a significant reduction of left ventricular end diastolic and end-systolic volume [(103,1+/-27,01 ml vs 89,2+/-21,1 ml, p=0,012), (44,65+/-15,83 ml vs 36.4+/-8.3 ml, p=0,003), respectively]. Conclusion(s): Treatment with sacubitril/valsartan prevented deterioration of myocardial deformation three months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction.