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Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis

BACKGROUND: Effects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a...

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Autores principales: Monosilio, Sara, Filomena, Domenico, Luongo, Federico, Sannino, Michele, Cimino, Sara, Neccia, Matteo, Mariani, Marco Valerio, Birtolo, Lucia Ilaria, Benedetti, Giulia, Tonti, Giovanni, Pedrizzetti, Gianni, Vizza, Carmine Dario, Maestrini, Viviana, Agati, Luciano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157573/
https://www.ncbi.nlm.nih.gov/pubmed/35665260
http://dx.doi.org/10.3389/fcvm.2022.883769
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author Monosilio, Sara
Filomena, Domenico
Luongo, Federico
Sannino, Michele
Cimino, Sara
Neccia, Matteo
Mariani, Marco Valerio
Birtolo, Lucia Ilaria
Benedetti, Giulia
Tonti, Giovanni
Pedrizzetti, Gianni
Vizza, Carmine Dario
Maestrini, Viviana
Agati, Luciano
author_facet Monosilio, Sara
Filomena, Domenico
Luongo, Federico
Sannino, Michele
Cimino, Sara
Neccia, Matteo
Mariani, Marco Valerio
Birtolo, Lucia Ilaria
Benedetti, Giulia
Tonti, Giovanni
Pedrizzetti, Gianni
Vizza, Carmine Dario
Maestrini, Viviana
Agati, Luciano
author_sort Monosilio, Sara
collection PubMed
description BACKGROUND: Effects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients undergoing S/V therapy. METHODS: Fifty HFrEF patients eligible to start a therapy with S/V were enrolled. Echocardiographic evaluation was performed at baseline and after 6 months of follow-up (FU). Beside standard evaluation, including global longitudinal strain (GLS), estimated hemodynamic forces (HDFs) and non-invasive pressure-volume curves (PV loop) were assessed using dedicated softwares. HDFs were evaluated over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). Parameters derived from estimated PV loop curves were left ventricular end-systolic elastance (E(es)), arterial elastance (E(a)), and ventricular-arterial coupling (VAC). RESULTS: At 6 months of FU indexed left ventricular end-diastolic and end-systolic volumes decreased (EDVi: 101 ± 28 mL vs. 86 ± 30 mL, p < 0.001; ESVi: 72 ± 23 mL vs. 55 ± 24 mL, p < 0.001), ejection fraction and GLS significantly improved (EF: 29 ± 6% vs. 37 ± 7%, p < 0.001; GLS: −9 ± 3% vs. −13 ± 4%, p < 0.001). A reduction of E(a) (2.11 ± 0.91 mmHg/mL vs. 1.72 ± 0.44 mmHg/mL, p = 0.008) and an improvement of E(es) (1.01 ± 0.37 mmHg/mL vs. 1.35 ± 0.6 mmHg/mL, p < 0.001) and VAC (2.3 ± 1.1 vs. 1.5 ± 0.7, p < 0.001) were observed. Re-alignment of HDFs occurred, with a reduction of diastolic L-S/A-B HDFs ratio [23 (20–35)% vs. 20 (11–28) %, p < 0.001]. CONCLUSION: S/V therapy leads to a complex phenomenon of reverse remodeling involving increased myocardial contractility, HDFs distribution improvement, and afterload reduction.
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spelling pubmed-91575732022-06-02 Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis Monosilio, Sara Filomena, Domenico Luongo, Federico Sannino, Michele Cimino, Sara Neccia, Matteo Mariani, Marco Valerio Birtolo, Lucia Ilaria Benedetti, Giulia Tonti, Giovanni Pedrizzetti, Gianni Vizza, Carmine Dario Maestrini, Viviana Agati, Luciano Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Effects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients undergoing S/V therapy. METHODS: Fifty HFrEF patients eligible to start a therapy with S/V were enrolled. Echocardiographic evaluation was performed at baseline and after 6 months of follow-up (FU). Beside standard evaluation, including global longitudinal strain (GLS), estimated hemodynamic forces (HDFs) and non-invasive pressure-volume curves (PV loop) were assessed using dedicated softwares. HDFs were evaluated over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). Parameters derived from estimated PV loop curves were left ventricular end-systolic elastance (E(es)), arterial elastance (E(a)), and ventricular-arterial coupling (VAC). RESULTS: At 6 months of FU indexed left ventricular end-diastolic and end-systolic volumes decreased (EDVi: 101 ± 28 mL vs. 86 ± 30 mL, p < 0.001; ESVi: 72 ± 23 mL vs. 55 ± 24 mL, p < 0.001), ejection fraction and GLS significantly improved (EF: 29 ± 6% vs. 37 ± 7%, p < 0.001; GLS: −9 ± 3% vs. −13 ± 4%, p < 0.001). A reduction of E(a) (2.11 ± 0.91 mmHg/mL vs. 1.72 ± 0.44 mmHg/mL, p = 0.008) and an improvement of E(es) (1.01 ± 0.37 mmHg/mL vs. 1.35 ± 0.6 mmHg/mL, p < 0.001) and VAC (2.3 ± 1.1 vs. 1.5 ± 0.7, p < 0.001) were observed. Re-alignment of HDFs occurred, with a reduction of diastolic L-S/A-B HDFs ratio [23 (20–35)% vs. 20 (11–28) %, p < 0.001]. CONCLUSION: S/V therapy leads to a complex phenomenon of reverse remodeling involving increased myocardial contractility, HDFs distribution improvement, and afterload reduction. Frontiers Media S.A. 2022-05-18 /pmc/articles/PMC9157573/ /pubmed/35665260 http://dx.doi.org/10.3389/fcvm.2022.883769 Text en Copyright © 2022 Monosilio, Filomena, Luongo, Sannino, Cimino, Neccia, Mariani, Birtolo, Benedetti, Tonti, Pedrizzetti, Vizza, Maestrini and Agati. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Monosilio, Sara
Filomena, Domenico
Luongo, Federico
Sannino, Michele
Cimino, Sara
Neccia, Matteo
Mariani, Marco Valerio
Birtolo, Lucia Ilaria
Benedetti, Giulia
Tonti, Giovanni
Pedrizzetti, Gianni
Vizza, Carmine Dario
Maestrini, Viviana
Agati, Luciano
Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title_full Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title_fullStr Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title_full_unstemmed Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title_short Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
title_sort cardiac and vascular remodeling after 6 months of therapy with sacubitril/valsartan: mechanistic insights from advanced echocardiographic analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157573/
https://www.ncbi.nlm.nih.gov/pubmed/35665260
http://dx.doi.org/10.3389/fcvm.2022.883769
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