sacubitril and Chronic-Disease

Heart failure (HF) is a clinical syndrome with symptoms and or signs caused by a structural and/or functional cardiac abnormality and associated with elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. It is classified according to left ventricular ejection fraction (LVEF): HF with reduced EF (HFrEF) with an LVEF of ≤40%, HF with mildly reduced EF (HFmrEF) with an LVEF of 41 to 49%, HF with preserved EF (HFpEF) with an LVEF of ≥50%, and HF with improved EF (HFimpEF) with a baseline LVEF of ≤40%, a ≥ 10% increase from baseline LVEF, and a second measurement of LVEF of >40%. Despite the remarkable progress in the management of HF over the past decades, its prognosis is still poor with higher rates of mortality and hospitalization due to worsening HF. Therefore, the development of novel strategies including pharmacologic therapy is needed to further improve its prognosis. Recent large-scale clinical trials have demonstrated the efficacy of newer pharmacological agents including angiotensin II receptor/neprilysin inhibitor (ARNI), sacubitril/valsartan, type 2 sodium-glucose cotransporter (SGLT2) inhibitors, dapagliflozin, empagliflozin and sotagliflozin, and soluble guanylyl cyclase (sGC) stimulator, vericiguat, and cardiac myosin activator, omecamtiv mecarbil. This review focuses the recent advances in the pharmacological agents for treatment of chronic heart failure, including their mechanisms of action, the evidence based on the clinical trials, and the guideline recommendations for their use.

Topics: Aminobutyrates; Biphenyl Compounds; Cardiac Myosins; Chronic Disease; Glucose; Heart Failure; Humans; Neprilysin; Receptors, Angiotensin; Sodium; Sodium-Glucose Transporter 2; Soluble Guanylyl Cyclase; Stroke Volume; Valsartan; Ventricular Function, Left

Left ventricular (LV) remodelling is a major mechanism underlying disease progression in patients with heart failure (HF) with reduced ejection fraction (EF). Previous studies that LVEF improvement and reverse remodelling can be achieved after therapy with Sacubitril/Valsartan in real-world settings. Therefore, we sought to investigate possible predictors of LV remodelling, in particular echocardiographic parameters derived by Tissue Doppler Imaging.. Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II-III were followed up between September 2016 and January 2019. All patients underwent clinical and echocardiography follow up at baseline and after 12 months of therapy with sacubitril/valsartan.. Fifty-four consecutive outpatients were enrolled in the study. At follow-up visit LVEF (38 ± 9 vs. 30 ± 5%,. Treatment with sacubitril/valsartan in patients with systolic dysfunction is associated with an improvement in LVEF in a real world scenario. Smaller LV volumes are associated with better reverse LV remodelling.

Topics: Aminobutyrates; Angiotensin Receptor Antagonists; Biphenyl Compounds; Chronic Disease; Heart Failure; Humans; Stroke Volume; Tetrazoles; Treatment Outcome; Valsartan; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling

Topics: Aminobutyrates; Angiotensin II Type 1 Receptor Blockers; Biphenyl Compounds; Chronic Disease; Defibrillators, Implantable; Female; Heart Failure; Humans; Male; Valsartan