IMPROVEMENT OF FUNCTIONAL CAPACITY IN SACUBITRIL-VALSARTAN TREATED PATIENTS ASSESSED BY CARDIOPULMONARY EXERCISE TEST

Abstract

Objective: The combination of neprilisin and angiotensin receptor inhibition (Sacubitril/Valsartan, i.e. ARNI) is recommended in heart failure guidelines for patients in NYHA class II-III with reduced left ventricular ejection fraction (LVEF). Sacubitril/Valsartan increases survival and quality of life. Moreover, due to its cardiac and hemodynamic effects, it could also affect exercise tolerance. Design and method: We studied the effects of ARNI on cardiopulmonary exercise test (CPET) in 35 patients [67 ± 11 years; Left ventricular ejection fraction (LVEF) 31 ± 6%; NT-proBNP 1822 ± 1651 pg/ml; ICD/CRT 26/35], being treated with increasing doses of Sacubitril/Valsartan up to the maximum tolerated dose (318 ± 36 mg/die) without side effects. In addition to CPET, plasma levels of pro-BNP, renal function, plasma electrolytes, echocardiocolorDoppler were performed at baseline and at 6 months follow-up. Results: No variations of renal function and/or kaliemia were observed, while NT-proBNP levels decreased significantly. Most CPET variables were improved by ARNI: an increase in peak VO2 (from 15.8 ± 3.4 to 17.0 ± 4.0 ml/Kg/min, p < 0.05) and in O2 pulse (from 11.5 ± 2.5 to 12.6 ± 2.4 ml/beat, p < 0.05), together with a decrease in VEVCO2 slope (from 35.2 ± 11.2 to 33.1 ± 12.3, p < 0.05) were observed. In addition, a significant relationship (p < 0.05) was present between the amount of increase in LVEF and that of O2 pulse in all patients (see Figure).Conclusions: Already in the short term, ARNI favourably affect global cardiopulmonary response to exercise in heart failure patients.