Cargando…
Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration
PURPOSE: Sacubitril/valsartan is a mainstay of the treatment of heart failure with reduced ejection fraction (HFrEF); however, its effects on exercise performance yielded conflicting results. Aim of our study was to evaluate the impact of sacubitril/valsartan on exercise parameters and echocardiogra...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427709/ https://www.ncbi.nlm.nih.gov/pubmed/37368004 http://dx.doi.org/10.1007/s00228-023-03527-y |
_version_ | 1785090302815502336 |
---|---|
author | Mapelli, Massimo Mattavelli, Irene Paolillo, Stefania Salvioni, Elisabetta Magrì, Damiano Galotta, Arianna De Martino, Fabiana Mantegazza, Valentina Vignati, Carlo Esposito, Immacolata Dell’Aversana, Simona Paolillo, Roberta Capovilla, Teresa Tamborini, Gloria Nepitella, Alessandro Alberto Filardi, Pasquale Perrone Agostoni, Piergiuseppe |
author_facet | Mapelli, Massimo Mattavelli, Irene Paolillo, Stefania Salvioni, Elisabetta Magrì, Damiano Galotta, Arianna De Martino, Fabiana Mantegazza, Valentina Vignati, Carlo Esposito, Immacolata Dell’Aversana, Simona Paolillo, Roberta Capovilla, Teresa Tamborini, Gloria Nepitella, Alessandro Alberto Filardi, Pasquale Perrone Agostoni, Piergiuseppe |
author_sort | Mapelli, Massimo |
collection | PubMed |
description | PURPOSE: Sacubitril/valsartan is a mainstay of the treatment of heart failure with reduced ejection fraction (HFrEF); however, its effects on exercise performance yielded conflicting results. Aim of our study was to evaluate the impact of sacubitril/valsartan on exercise parameters and echocardiographic and biomarker changes at different drug doses. METHODS: We prospectively enrolled consecutive HFrEF outpatients eligible to start sacubitril/valsartan. Patients underwent clinical assessment, cardiopulmonary exercise test (CPET), blood sampling, echocardiography, and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Sacubitril/valsartan was introduced at 24/26 mg b.i.d. dose and progressively uptitrated in a standard monthly-based fashion to 97/103 mg b.i.d. or maximum tolerated dose. Study procedures were repeated at each titration visit and 6 months after reaching the maximum tolerated dose. RESULTS: Ninety-six patients completed the study, 73 (75%) reached maximum sacubitril/valsartan dose. We observed a significant improvement in functional capacity across all study steps: oxygen intake increased, at peak exercise (from 15.6 ± 4.5 to 16.5 ± 4.9 mL/min/kg; p trend = 0.001), while minute ventilation/carbon dioxide production relationship reduced in patients with an abnormal value at baseline. Sacubitril/valsartan induced positive left ventricle reverse remodeling (EF from 31 ± 5 to 37 ± 8%; p trend < 0.001), while NT-proBNP reduced from 1179 [610–2757] to 780 [372–1344] pg/ml (p trend < 0.0001). NYHA functional class and the subjective perception of limitation in daily life at KCCQ-12 significantly improved. The Metabolic Exercise Cardiac Kidney Index (MECKI) score progressively improved from 4.35 [2.42–7.71] to 2.35% [1.24–4.96], p = 0.003. CONCLUSIONS: A holistic and progressive HF improvement was observed with sacubitril/valsartan in parallel with quality of life. Likewise, a prognostic enhancement was observed. |
format | Online Article Text |
id | pubmed-10427709 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-104277092023-08-17 Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration Mapelli, Massimo Mattavelli, Irene Paolillo, Stefania Salvioni, Elisabetta Magrì, Damiano Galotta, Arianna De Martino, Fabiana Mantegazza, Valentina Vignati, Carlo Esposito, Immacolata Dell’Aversana, Simona Paolillo, Roberta Capovilla, Teresa Tamborini, Gloria Nepitella, Alessandro Alberto Filardi, Pasquale Perrone Agostoni, Piergiuseppe Eur J Clin Pharmacol Research PURPOSE: Sacubitril/valsartan is a mainstay of the treatment of heart failure with reduced ejection fraction (HFrEF); however, its effects on exercise performance yielded conflicting results. Aim of our study was to evaluate the impact of sacubitril/valsartan on exercise parameters and echocardiographic and biomarker changes at different drug doses. METHODS: We prospectively enrolled consecutive HFrEF outpatients eligible to start sacubitril/valsartan. Patients underwent clinical assessment, cardiopulmonary exercise test (CPET), blood sampling, echocardiography, and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Sacubitril/valsartan was introduced at 24/26 mg b.i.d. dose and progressively uptitrated in a standard monthly-based fashion to 97/103 mg b.i.d. or maximum tolerated dose. Study procedures were repeated at each titration visit and 6 months after reaching the maximum tolerated dose. RESULTS: Ninety-six patients completed the study, 73 (75%) reached maximum sacubitril/valsartan dose. We observed a significant improvement in functional capacity across all study steps: oxygen intake increased, at peak exercise (from 15.6 ± 4.5 to 16.5 ± 4.9 mL/min/kg; p trend = 0.001), while minute ventilation/carbon dioxide production relationship reduced in patients with an abnormal value at baseline. Sacubitril/valsartan induced positive left ventricle reverse remodeling (EF from 31 ± 5 to 37 ± 8%; p trend < 0.001), while NT-proBNP reduced from 1179 [610–2757] to 780 [372–1344] pg/ml (p trend < 0.0001). NYHA functional class and the subjective perception of limitation in daily life at KCCQ-12 significantly improved. The Metabolic Exercise Cardiac Kidney Index (MECKI) score progressively improved from 4.35 [2.42–7.71] to 2.35% [1.24–4.96], p = 0.003. CONCLUSIONS: A holistic and progressive HF improvement was observed with sacubitril/valsartan in parallel with quality of life. Likewise, a prognostic enhancement was observed. Springer Berlin Heidelberg 2023-06-27 2023 /pmc/articles/PMC10427709/ /pubmed/37368004 http://dx.doi.org/10.1007/s00228-023-03527-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Research Mapelli, Massimo Mattavelli, Irene Paolillo, Stefania Salvioni, Elisabetta Magrì, Damiano Galotta, Arianna De Martino, Fabiana Mantegazza, Valentina Vignati, Carlo Esposito, Immacolata Dell’Aversana, Simona Paolillo, Roberta Capovilla, Teresa Tamborini, Gloria Nepitella, Alessandro Alberto Filardi, Pasquale Perrone Agostoni, Piergiuseppe Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title | Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title_full | Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title_fullStr | Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title_full_unstemmed | Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title_short | Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
title_sort | effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427709/ https://www.ncbi.nlm.nih.gov/pubmed/37368004 http://dx.doi.org/10.1007/s00228-023-03527-y |
work_keys_str_mv | AT mapellimassimo effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT mattavelliirene effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT paolillostefania effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT salvionielisabetta effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT magridamiano effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT galottaarianna effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT demartinofabiana effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT mantegazzavalentina effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT vignaticarlo effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT espositoimmacolata effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT dellaversanasimona effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT paolilloroberta effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT capovillateresa effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT tamborinigloria effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT nepitellaalessandroalberto effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT filardipasqualeperrone effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration AT agostonipiergiuseppe effectsofsacubitrilvalsartanonexercisecapacityaprognosticimprovementthatstartsduringuptitration |