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Sacubitril/Valsartan (sac/val) has improved clinical prognosis in patients affected by heart failure (HF) with reduced ejection fraction (HFrEF). HF and type 2 diabetes mellitus (T2DM) frequently coexist, with a prevalence of T2DM of 35%–40% in patients with HF. T2DM is the third co-morbidities in patients with HF and a strong independent risk factor for the progression of HF. In a post hoc analysis of PARADIGM-HF, improved glycemic control was shown in patients with T2DM and HFrEF receiving sac/val compared to enalapril at 12 months of follow-up. The aim of the present study was to evaluate, in a series of repeated observations in 90 HFrEF patients, the long term effect of sac/val treatment on renal function, glycometabolic state and insulin sensitivity parameters, according to diabetic status. We studied 90 patients (74 men and 16 women, mean age 68 ± 10 years, 60 diabetics and 30 non-diabetics) suffering from HFrEF and still symptomatic despite optimal pharmacological therapy. Patients with left ventricular ejection fraction (LVEF) <35% and II-III NYHA functional class were enrolled. All patients underwent clinical-instrumental and laboratory determinations and Minnesota Living with HF Questionnaire (MLHFQ) every 6 months until 30 months to evaluate benefits and adverse events. After 30 months follow-up, we observed a significant improvement in glycometabolic parameters including HbA1c, fasting glucose and insulin, insulin-like growth factor-1 (IGF-1), HOMA index, and LDL cholesterol. Moreover, renal function, NTpro-BNP levels and echocardiographic parameters significantly improved. In diabetic patients a significant reduction in use of oral antidiabetic drugs and insulin was observed after 30 months of sac/val treatment. In the whole population, multivariate analysis shows that the evolution of cardiac index (CI) was significantly associated to simultaneous changes in HOMA, IGF-1 and visit; per each visit and for 1 ng/ml increase in IGF-1 there was an increase in CI of 64.77 ml/min/m2 (p < 0.0001) and 0.98 ml/min/m2 (p = 0.003), respectively, whereas 1 point increase in HOMA was associated with a −7.33 ml/min/m2 (p = 0.003) reduction in CI. The present data confirm persistent metabolic improvement in patients with HFrEF after treatment with sac/val and highlights its potential therapeutical role in patients with metabolic comorbidities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the clinical efficacy and safety of sacubitril valsartan in the treatment of heart failure induced by ischemic cardiomyopathy(ICM) and dilated cardiomyopathy (DCM). METHODS: Totally 124 patients with heart failure admitted into Jiangsu Province Hospital from Mar. 2018 to Mar. 2020 were selected and divided into ICM group (n =59) and DCM group (n = 65) according to the causes of heart failure. Both groups were given conventional anti-heart failure drugs combined with sacubitril valsartan orally for continuous 12 months. The blood pressure, N-terminal B-type natriuretic peptidogen ( NT-proBNP ), serum creatinine ( Cr ), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and serum potassium ion concentration, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) levels before and after 6 and 12 months of treatment were observed in both groups. The 6 min walk distance (6MWT), Minnesota living with heart failure questionnaire ( mlHFQ) scores before and after 12 months of treatment were observed in both groups, and the incidences of adverse drug reactions were compared between two groups. RESULTS: The differences in NT-proBNP, Cr, ALT and AST levels, and serum potassium ion concentration between two groups after 6 and 12 months of treatment were not statistically significant (P>0. 05). Compared with before treatment, the NT-proBNP and LVEDD levels were significantly decreased and the LVEF levels were significantly increased in both groups after 6 months and 12 months of treatment, with statistically significant differeces (P<0. 05). The LVEF level was significantly higher and the LVEDD level was significantly lower in the ICM group than in the DCM group after 12 months of treatment, with statistically significant differences (P<0. 05). The 6MWT was significantly longer and the mlHFQ scores was significantly lower in both groups after 12 months of treatment, and the differences were statistically significant compared with those of before treatment (P<0. 05); while the 6MWT of the ICM group was significantly longer than that of the DCM group after 12 months of treatment, and the difference between two groups was statistically significant (P <0. 05). The incidence of adverse drug reactions of the ICM group was 5. 08% (3/59), and that of the DCM group was 6. 15% (4/65), the difference between two groups was not statistically significant (P>0. 05). CONCLUSIONS: Sacubitril valsartan can improve cardiac function and life quality in patients with heart failure induced by dilated cardiomyopathy and ischemic cardiomyopathy, and inhibit the ventricular remodeling; the improvement effect of sacubitril valsartan in patients with heart failure induced by ischemic cardiomyopathy is better than that of heart failure induced by dilated cardiomyopathy. [ABSTRACT FROM AUTHOR]

Heart failure (HF) represents a widespread health problem characterized by high morbidity and mortality. Sacubitril/Valsartan (sac/val) has improved clinical prognosis in patients affected by HF with reduced ejection fraction (HFrEF). The aim of this study was to evaluate the effectiveness and durability of sac/val treatment on the clinical, hemodynamic and echocardiographic parameters, in real-life consecutive HFrEF outpatients, evaluated up to 2-years of follow-up. We collected 300 repeated observations over time in 60 patients suffering of HFrEF and symptomatic despite optimal drug therapy. Patients with left ventricular ejection fraction (LVEF) <35 and II-III NYHA functional class were considered. All patients underwent to clinical-instrumental and laboratory determinations and Minnesota Living with HF Questionnaire (MLHFQ) every 6 months until 24 months to evaluate possible clinical benefits and adverse events. During a 2-year follow-up period and through a 6-monthly control of the study variables both clinical, hemodynamic, biochemical and echocardiographic parameters significantly improved, in particular cardiac index (CI), both atrial and ventricular volumes and global longitudinal strain (GLS). Furthermore, there was a reduction of NT-proBNP levels and betterment of renal function and NYHA functional class, demonstrating the efficacy and durability of sac/val treatment. In a multiple linear mixed model the longitudinal evolutions of CI were associated to concomitant changes of GLS and E/e' ratio. Our study, contemplating the collection of 300 repeated observations in 60 patients, provides a complete and detailed demonstration of sac/val effects, showing effectiveness, safety and effect durability of the treatment every 6 months up to 2-years of follow-up with significant improvement of several clinical, hemodynamic and echocardiographic parameters in HFrEF outpatients. [ABSTRACT FROM AUTHOR]