Transition from angiotensin-converting enzyme inhibitor/angiotensin-II-receptor-blocker to sacubitril/valsartan in chronic heart failure patients: Initial experiences in clinical practice
Abstract
Background: Sacubitril/valsartan (S/V) therapy has been demonstrated to improve prognosis of systolic heart failure (HF) patients when compared to standard therapy with ACEi. The purpose of this investigation was to document the safety and consequences of transition from ACEi/angiotensin-II receptor blocker (ARB) to S/V in chronic stable HF patients.
Methods: A group of 12 stable HF outpatients (11 males, 1 female) was enrolled (NYHA 2.7. +-. 0.7, 42% with coronary artery disease (CAD), average left-ventricle ejection fraction (LVEF) 26.5%). Patients were converted from ACEi/ARB to S/V.
Laboratory evaluation, Minnesota Living with Heart Failure Questionnaire (MLHFQ), six-minute walk test (6MWT) were performed before the conversion and at 3-month follow-up visit. Results: Conversion from ACEi/ARB to S/V was not associated with any adverse event.
After 3 months, S/V therapy decreased blood pressure (-14.8mmHg for systolic BP, -9.6mmHg for diastolic BP) and serum potassium (-0.27mmol.l-1, all p <0.05). No worsening of renal function occurred (creatinine -7.8μmol.l-1, p =0.12, estimated glomerular filtration rate +0.08ml.s-1.1.73m-2, p =0.14).
B-type natriuretic peptide (BNP) level remained unchanged (p =0.18), but NT-proBNP level decreased significantly (median 1012ng.l-1 at baseline, 559.4ng.l-1 at follow-up, p =0.005). A slight but significant decrease in high-sensitivity cardiac troponin T (hs-cTnT) was observed (median 14.76ng.l-1 at baseline, 12.63ng.l-1 at follow-up, p =0.001).
An improvement in MLHFQ total score (-8 points, p =0.006) and in 6MWT by 55m (p =0.0007) was noted, which was not due to increased effort. Conclusion: The transition from ACEi/ARB to S/V therapy appears to be safe and leads to an improvement in exercise tolerance and quality of life.