Abstract
Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.
Highlights
Sacubitril/valsartan is the latest “disease-modifying drug” approved for the management of patients with heart failure with reduced ejection fraction (HFrEF) [1].In addition to a reduction in the rate of mortality and hospitalisation [2,3], both randomised clinical trials and real-life studies have shown that sacubitril/valsartan induced the “reverse remodelling” of the left ventricle (LV), with a reduction in the ventricular volumes, an increase in the ejection fraction (EF) [4,5], an improvement in the diastolic function [6,7], and a reduction in the degree of functional mitral regurgitation [8]
The main findings of this study are as follows: (1) sacubitril/valsartan improves right ventricle (RV)-pulmonary artery (RV-PA) coupling, (2) this improvement is related to both an increase in the tricuspid annular plane systolic excursion (TAPSE) and a reduction in the pulmonary arterial pressure, and (3) the improvement in the TAPSE/pulmonary artery systolic pressure (PASP) ratio is independent of the LV reverse remodelling
Compared with right cardiac catheterisation, which is the reference method, two-dimensional echocardiography allows the calculation of combined indices such as the TAPSE/PASP ratio, which is a reliable index of RV-PA coupling [28,29]
Summary
Sacubitril/valsartan is the latest “disease-modifying drug” approved for the management of patients with heart failure with reduced ejection fraction (HFrEF) [1]. In addition to a reduction in the rate of mortality and hospitalisation [2,3], both randomised clinical trials and real-life studies have shown that sacubitril/valsartan induced the “reverse remodelling” of the left ventricle (LV), with a reduction in the ventricular volumes, an increase in the ejection fraction (EF) [4,5], an improvement in the diastolic function [6,7], and a reduction in the degree of functional mitral regurgitation [8]. The tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been proposed as the best echocardiographic method to evaluate it [13]. In patients with HFrEF, the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown; we aimed to analyse the effect of sacubitril/valsartan on the TAPSE/PASP ratio in this patient group
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