Sacubitril/Valsartan for heart failure in adults with systemic right ventricle: A single center safety and efficacy experience

Abstract

Heart failure in adult with congenital heart disease is an important cause of morbi-mortality. Sacubitril/Valsartan has been validated for the treatment of heart failure in adults with left ventricular dysfunction. The aim of this study was to assess safety and efficacy of Sacubitril/Valsartan in symptomatic adults with systemic right ventricle dysfunction. This is a retrospective and single center study (Quebec Heart and Lung Institute, Quebec City, Canada). Eight patients (mean age 41 ± 9.2 years, 5 males) with a significant systemic right ventricle dysfunction in New York functional class II–III despite optimal heart failure medication were included. Sacubitril/Valsartan was up titrated at the maximal dosage tolerated. The mean dosage reached was 85 ± 22 mg/90 ± 24 mg. During a median follow-up of 248 (213–430) days, systolic (121 ± 13 vs. 116 ± 13 mmHg, P = 0.238) and diastolic (76 ± 6 mmHg vs. 72 ± 5 mmHg, P = 0.105) blood pressure, potassium (4.1 ± 0.4 mmol/L vs. 3.9 ± 0.2 mmol/L, P = 0.111) and creatinine (71.7 ± 14.5 μmol/L vs. 68.9 ± 14.7 μmol/L, P = 0.516) levels remained stable. No discontinuation, reduction in dose or side effects were noted. A significant improvement in functional status was observed ( P = 0.03): 6 patients had a New York Heart Association class improvement and 2 remained in the same class ( Fig. 1 ). Maximal oxygen uptake, NTproBNP levels and echocardiographic data did not reach significant improvement. Sacubitril/Valsartan titration in a population of patients with congenital heart disease and significant right ventricle dysfunction was well tolerated and associated with significant improvement in functional status class. Whether Sacubitril/Valsartan improved right ventricle remodeling or decrease heart failure hospitalization or mortality in that population remained to determined.