Effect of Sacubitril/Valsartan on Echocardiographic Parameters and Functional Class in Patients of Heart Failure with Reduced Ejection Fraction
Syed Dilbahar Ali Shah
Dow University of Health Sciences / Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Arshad Ali Shah
Dow University of Health Sciences / Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Muhammad Sami Khan
Dow University of Health Sciences / Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Faisal Ahmed
Cardiology Department, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Hana Shamim
Cardiology Department, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Syed Arif Ali
School of Public Health, Dow University of Health Sciences, Pakistan.
Muhammad Nawaz Lashari
Dow University of Health Sciences / Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Pakistan.
Dileep Kumar *
Mohammed Bin Khalifa Specialist Cardiac Centre, Bahrain.
*Author to whom correspondence should be addressed.
Abstract
Background: This study sought to determine, in retrospect, the effect of Sacubitril/Valsartan on the echocardiographic and functional class of ambulatory HFrEF patients taking conventional heart failure therapy.
Methods: We conducted a retrospective observational single-center cohort of ninety HFrEF patients with NYHA Class II-III attending as an outpatient at a tertiary cardiac care facility between November 2018 and January 2020. Standardized two-dimensional transthoracic echocardiography and functional class evaluation were conducted at baseline and after 03-month of SV treatment.
Results: At 03-month follow-up evaluation, SV treatment was found to contribute substantially in reversing the cardiac remodeling of HFrEF patients as evidenced by improvement in LVEF (28.51±5.06 to 36.01±10.63; p < 0.001), LVEDD (57.29±7.99 to 53.14±8.22; p <0.001), and LVESD (46.07±9.49 to 43.20±9.22; p <0.001). Additionally, an improvement in sPAP (34.13±9.49 to 32.46±8.14; p <0.001) was observed along with a significant NYHA functional class recovery (2.76 to 1.89, p < 0.001). Upon gender-based stratification, the data suggested no gender-based differences in reverse remodeling effects of SV; though statistically insignificant, LA (38.51±8.23 to 37.3±5.92 mm) and RV (27.10±5.74 to 26.42±2.81 mm) diameters were observed to reduce only in men.
Conclusion: Our study maintained that earlier commencement of SV in parallel with conventional heart failure therapy results in a significant amount of improvement in LVEF, LVEDD, LVESD, and sPAP in HFrEF patients irrespective of their gender. Simultaneously, SV alleviates the heart failure-related morbidity through rapid functional status (NYHA Class) recovery.
Keywords: Sacubitril/Valsartan, heart failure, 2-D echocardiography, NYHA functional class, sex differences