Sacubitril/valsartan has an underestimated impact on the right ventricle in patients with sleep-disordered breathing, especially central sleep apnoea syndrome.

Laura Sofia Cardelli, François Picard, Philippe Berdague, Audrey Agullo, Frédéric Georger, François Roubille, Dany Jaffuel, Erika Nogue, Arnaud Bourdin, Nicolas Molinari, Mariarosaria Magaldi, Gaetan Richard, Michel Galiner, Elvira Prunet

Journal: Archives of cardiovascular diseases 2024;117(6-7):409-416

PMID: 38811278

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Abstract

BACKGROUND

Sacubitril/valsartan has been demonstrated to significantly improve left ventricular performance and remodelling in patients with heart failure. However, its effects on the right ventricle in patients with chronic heart failure and sleep-disordered breathing (SDB) have not been studied.

AIM

To investigate the impact of sacubitril/valsartan treatment on right ventricular function in patients with SDB.

METHODS

This was a subanalysis of an observational prospective multicentre study involving 101 patients. At inclusion, patients were evaluated by echocardiography and nocturnal ventilatory polygraphy, which allowed patients to be divided into three groups: "central-SDB"; "obstructive-SDB"; and "no-SDB".

RESULTS

After 3 months of sacubitril/valsartan therapy, a positive impact on right ventricular function was observed. In the general population, tricuspid annular plane systolic excursion increased by +1.32±4.74mm (P=0.024) and systolic pulmonary artery pressure decreased by -3.1±10.91mmHg (P=0.048). The central-SDB group experienced the greatest echocardiographic improvement, with a significant increase in tricuspid annular plane systolic excursion of +2.1±4.9mm (P=0.045) and a significant reduction in systolic pulmonary artery pressure of -8.4±9.7mmHg (P=0.001).

CONCLUSIONS

Sacubitril/valsartan improved right ventricular function in patients with heart failure and SDB after only 3 months of treatment. The greatest improvement in right ventricular function was observed in the central-SDB group.

Address: Cardiology Department, Versilia Hospital, 55041 Camaiore, Italy.; Department of Advanced Biomedical Science, Federico II University of Naples, 80131 Napoli, Italy.; Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France.; Inserm, IDESP, PreMedical INRIA, CHU de Montpellier, Montpellier University, 34295 Montpellier, France.; Department of Cardiology, Béziers Hospital, 34500 Béziers, France.; Cardiology Department, Toulouse-Rangueil University Hospital, 31400 Toulouse, France; MMP Department, Faculty of Health, Toulouse III Paul-Sabatier University, 31062 Toulouse, France.; Heart Failure Unit, Haut-Lévêque Hospital, 33604 Pessac, France.; Cardiology Department, Montpellier University, Nîmes University Hospital, 30900 Nîmes, France.; Inserm U1046, PhyMedExp, Department of Respiratory Diseases, CNRS, UMR 9214, CHU de Montpellier, University of Montpellier, 34295 Montpellier, France.; Cardiology Department, Arnaud-De-Villeneuve Hospital, 34090 Montpellier, France. Electronic address: [email protected].

DOI: 10.1016/j.acvd.2024.04.003

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MeSH Terms: Humans, Valsartan, Drug Combinations, Male, Female, Aminobutyrates, Ventricular Function, Right, Prospective Studies, Biphenyl Compounds, Middle Aged, Treatment Outcome, Aged, Heart Failure, Time Factors, Recovery of Function, Sleep Apnea, Central, Angiotensin II Type 1 Receptor Blockers, Tetrazoles, Protease Inhibitors, Polysomnography, Neprilysin, Chronic Disease