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Diabetes often coexists with cardiovascular complications, which are also a common cause of death in diabetes patients. Therefore, in addition to improving glucose metabolism, it is also necessary to control cardiovascular complications in diabetes patients. Sacubitril valsartan is a novel compound with dual actions of inhibiting neprilysin and angiotensin receptor, and it is commonly used as a heart failure drug in clinical practice. Recent studies suggest that sacubitril valsartan may also have potential metabolic benefits, improving cardiac function while improving glycemic control in diabetes patients, and it is expected to become a drug that can be used routinely in diabetes, bringing cardiovascular and metabolic benefits. This review focuses on the clinical efficacy and metabolic benefits of sacubitril valsartan in the treatment of diabetes patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the efficacy and safety of different doses of sacubitril valsartan in the treatment of elderly patients with chronic heart failure. METHODS: A total of 155 elderly patients with chronic heart failure admitted into the hospital from 2019 to 2021 were divided into the group A (n = 35), group B (n = 62) and group C (n =58) according to different dosage regimen. Group A was given 100 mg sacubitril valsartan twice a day (standard dose), group B received 50 mg sacubitril valsartan twice a day (lower dose), group C was treated with 25 mg sacubitril valsartan twice a day (lower dose). After continuous medication for 12 months, the total effective rate, improvement in cardiac structure and function, and incidence of adverse events were compared among three groups before and after treatment. RESULTS: After treatment, the total effective rates of the three groups were respectively 94. 3%(33/35), 90. 3%(56/62) and 69. 0%(40/58), with statistically significant differences (P < 0. 001). After treatment, the left ventricular ejection fraction in group A and group B was respectively (63. 07± 7. 95)% and (55. 52±11. 31)%, which were significantly improved compared with those before treatment, and the improvement in group A was more significant than that in group B, while there was no significant improvement in group C. The left atrial diameter of patients in group A and group B was respectively (38. 04±7. 04) mm and (39. 14± 5. 67) mm, which was significantly improved compared with those before treatment, while there was no significant improvement in group C. The left ventricular end-diastolic diameter in group A and group B was respectively (46. 03±6. 91) mm and (48. 80±6. 95) mm, which were significantly improved compared with those before treatment, while there was no significant improvement in group C. There was no significant difference in the incidence of adverse drug reactions among three groups (P > 0. 05). CONCLUSIONS: In the treatment of chronic heart failure in elderly patients, if multiple risk factors are considered and the standard dose cannot be tolerated, a reduced dose of 50 mg twice daily can be used, which may have the same clinical benefits. However, a reduced dose of 25 mg twice daily is not recommended. [ABSTRACT FROM AUTHOR]

[Objectives] To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction (STE-MI). [Methods] 41 cases of STEMI patients (qi and yin deficiency and blood stasis and obstruction) hospitalized in Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2020 to June 2021 were randomly divided into 21 cases in the treatment group and 20 cases in the control group, and the two groups were given standardized Western medicine treatment as soon as possible after PCI. The control group was treated with Sacubitril Valsartan, and the treatment group was treated with Guanxin-V Mixture on the basis of treatment in the control group. The patients in the two groups were treated for 3 months, and the TCM syndrome score, left ventricular ejection fraction (LVEF), and N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) levels, and the incidence of heart failure and adverse reactions in the two groups after treatment were recorded. [Results] After the treatment, the TCM syndrome score and serum NT-proBNP, IL-6 and hs-CRP levels of the two groups significantly decreased (P<0.05), and the levels of the treatment group were significantly lower than those of the control group (P<0.05); the LVEF of the two groups significantly increased (P<0.05), and the level of the treatment group was significantly higher than that of the control group (P<0.05). Comparison of the incidence of heart failure and adverse reactions in the two groups showed no statistically significant differences (P>0.05). [Conclusions] Guanxin-V Mixture combined with Sacubitril Valsartan could significantly improve cardiac function in STEMI patients undergoing PCI, and its effect may be related to the suppression of inflammatory response. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy and safety of sacubitril valsartan in the treatment of heart failure (HF) of midrange ejection fraction（HFmrEF）in patients after acute myocardial infarction (AMI). Methods A total of 102 patients with HFmrEF after AMI were divided into the control group and the experimental group, with 51 cases in each group. The control group was given conventional treatment for AMI and anti-HF treatment, and the angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin Ⅱ receptor blocker (ARB) was used without contraindications. The experimental group was replaced by ACEI/ARB with sacubitril valsartan on the basis of the control group. After 6 months of treatment, the total effective rates of the two groups after treatment were analyzed, and the cardiac function, N-terminal pro-brain natriuretic peptide (NT-proBNP) and serum inflammatory factor C-reactive protein (CRP) were compared before and after treatment. The occurrence of adverse reactions after treatment was recorded. Kaplan-Meier method was used to analyze the cumulative cardiovascular mortality, HF rehospitalization rate and end-event-free survival after 6 months of treatment in two groups. Results After treatment, there was no significant difference in the occurrence of adverse reactions between the two groups (P＞0.05). The total effective rate was higher in the experimental group than that of the control group (P＜0.05). Compared with before treatment, left ventricular ejection fraction (LVEF), stroke volume (SV), mitral diastolic blood flow velocity E peak and A peak ratio (E/A) and 6 min walking distance (6MWD) were increased in the two groups, and left ventricular enddiastolic diameter (LVEDD) and left atrial diameter (LAD) were decreased in the two groups after treatment (all P＜0.05). After treatment, LVEF, SV, E/A and 6MWD were higher in the experimental group than those in the control group (P＜0.05). LVEDD and LAD were lower than those in the control group (all P＜0.05). Compared with results before treatment, NT proBNP and CRP were decreased after treatment in the experiment group than those in the control group (P＜0.05). There was no significant difference in the cumulative cardiovascular mortality between the experiment group and the control group (3.9% vs. 5.9%，P=0.524). The cumulative HF rehospitalization rate was lower in the experimental group than that of the control group (9.8% vs. 23.5%，P=0.042). The cumulative end-point-free survival rate was higher in the experiment group than that of the control group (86.3% vs. 70.6%, P=0.037). Conclusion Sacubitril valsartan is safer and more effective than ACEI/ARB in the treatment of AMI patients with HFmrEF, and it is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Angiotensin receptor/neprilysin inhibitors (ARNI) have become a pillar of heart failure (HF) management. Clinicians gain practical insight into the use of sacubitril/valsartan in patients with HF with reduced ejection fraction (EF) from a comprehensive overview based on clinical experience with ARNI therapy. The objective was to develop a consensus document addressing common concerns regarding the use of ARNI in patients with HF in clinical settings in India. Subject matter experts (SMEs) from India with decision-making expertise in the management of HF were identified to address experiences of ARNI use in Indian patients, its function in reversing myocardial remodeling, improvement in health status, and its safety. In regional meetings, five SMEs from India who consented to participate discussed data from practical experiences and current evidence. ARNI has been shown to substantially enhance EF 5%–10% in a majority of HF patients, although the range of improvement could vary widely in a few patients. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blocker antagonists have been eclipsed by ARNI. Patients who have diminished or declining estimated glomerular filtration rates are more likely than those with normal renal function to experience hyperkalemia. It is prudent to consistently monitor potassium levels in patients with borderline chronic kidney disease. In India, potassium binders may be used to temporarily control hyperkalemia caused by ARNI. Patients with a systolic blood pressure of <100 mmHg may initiate taking ARNI while being tracked for clinical symptoms. In clinical practice, symptomatic improvement with ARNI is observed soon after initiating, even before alterations noted in echocardiography. [ABSTRACT FROM AUTHOR]

Background: Sacubitril‐valsartan (SV) monotherapy has been shown to help patients with Heart failure with reduced ejection fraction (HFrEF), but whether adding a sodium‐glucose cotransporter‐2 inhibitor (SGLT2i) improves treatment results even more is unknown. Hypothesis: The goal of this study was to look at the efficacy of SV with additional SGLT2i in HFrEF patients. Methods: For this study, several databases, such as PubMed, EMBASE, Web of Science, and the Cochrane Library, were searched. A coherent search approach was used for data extraction. Review Manager 5.2 and MedCalc were used for conducting the meta‐analysis and bias analysis. A meta‐regression study correlates patient mean age with primary and secondary outcomes. Results: Seven trials totaling 16 100 patients were included in this meta‐analysis. All‐cause mortality, cardiovascular mortality, and improvement in mean left ventricular ejection fraction (LVEF) were the study's major objectives, while hospitalization for heart failure (HF) was calculated to be its secondary outcome. Our analysis showed that HFrEF patients receiving the combination of SV and SGLT2i had better treatment outcomes than the standard SV monotherapy, with risk ratios of 0.76 (0.65–0.88) for all‐cause mortality, 0.65 (0.49–0.86) for cardiovascular mortality, 1.41 (−0.59 to 3.42) for change in mean LVEF, and 0.80 (0.64–1.01) for hospitalization for HF. According to the regression analysis, older HFrEF patients have higher rates of hospitalization, cardiovascular disease, and overall death. Conclusions: The combination of SV and SGLT2i may have a greater cardiovascular protective effect and minimize the risk of death or hospitalization due to heart failure in HFrEF. [ABSTRACT FROM AUTHOR]

BackgroundIn PIONEER-HF (Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on NT-pro BNP in Patients Stabilized From an Acute Heart Failure Episode), the in-hospital initiation of sacubitril/valsartan in patients hospitalized for acute decompensated heart failure (ADHF) was well-tolerated and led to improved outcomes. We aim to determine the representativeness of the PIONEER-HF trial among patients hospitalized for ADHF using real-world data.MethodsThe study population was derived from all patients discharged alive for ADHF in the Get With The Guidelines-HF registry from 2006 to 2018 with HF with reduced ejection fraction (HFrEF; all HFrEF with ADHF). We then determined the proportion of patients meeting PIONEER-HF eligibility criteria (PIONEER-HF eligible) and those meeting a set of limited eligibility criteria (actionable cohort). Rates of HF readmissions and all-cause mortality were then compared between the all HFrEF with ADHF, PIONEER-HF eligible, and actionable cohorts using linked Medicare claims data.ResultsA total of 99 767 patients with HFrEF in Get With The Guidelines-HF were hospitalized for ADHF. PIONEER-HF inclusion criteria were met by 71 633 (71.8%) patients, and both inclusion and exclusion criteria were met by 20 704 (20.8%) patients. Further, 68 739 (68.9%) patients met the criteria for the actionable cohort. Among the Centers for Medicare and Medicaid-linked patients, the HF rehospitalization rate at 1 year was 35.1% (95% CI, 34.5-35.8) for all HFrEF with ADHF patients, 32.6% (95% CI, 31.3-33.9) for the PIONEER-HF eligible cohort, and 33.1% (95% CI, 32.3-33.9) for the actionable cohort. The 1-year all-cause mortality was 36.7% (95% CI, 36.1-7.4) for all HFrEF with ADHF patients, 31.6% (95% CI, 30.3-32.9) for the PIONEER-HF eligible cohort, and 32.2% (95% CI, 31.4-33.0) for the actionable cohort.ConclusionsPatient characteristics and clinical outcomes for patients eligible for PIONEER-HF only modestly differ when compared with those encountered in routine practice, suggesting that the in-hospital initiation of sacubitril/valsartan should be routinely considered for patients with HFrEF hospitalized for ADHF.

Angiotensin receptor/neprilysin inhibitors (ARNI) have become a pillar of heart failure (HF) management. Clinicians gain practical insight into the use of sacubitril/valsartan in patients with HF with reduced ejection fraction (EF) from a comprehensive overview based on clinical experience with ARNI therapy. The objective was to develop a consensus document addressing common concerns regarding the use of ARNI in patients with HF in clinical settings in India. Subject matter experts (SMEs) from India with decision-making expertise in the management of HF were identified to address experiences of ARNI use in Indian patients, its function in reversing myocardial remodeling, improvement in health status, and its safety. In regional meetings, five SMEs from India who consented to participate discussed data from practical experiences and current evidence. ARNI has been shown to substantially enhance EF 5%–10% in a majority of HF patients, although the range of improvement could vary widely in a few patients. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blocker antagonists have been eclipsed by ARNI. Patients who have diminished or declining estimated glomerular filtration rates are more likely than those with normal renal function to experience hyperkalemia. It is prudent to consistently monitor potassium levels in patients with borderline chronic kidney disease. In India, potassium binders may be used to temporarily control hyperkalemia caused by ARNI. Patients with a systolic blood pressure of

Abstract Aims The angiotensin receptor‐neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all‐cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up‐titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up‐titration success. Methods and results From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1–72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P‐value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV‐FW‐LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794–0.954) to predict maximum Sac/Val dose tolerability. Conclusions Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The angiotensin receptor‐neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all‐cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up‐titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up‐titration success. Methods and results: From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1–72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P‐value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV‐FW‐LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794–0.954) to predict maximum Sac/Val dose tolerability. Conclusions: Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE <16 mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically evaluate the efficacy and safety of sacubitril valsartan in the treatment of hypertension, so as to provide evidence-based medical evidence for clinical practice. METHODS: PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data and VIP were retrieved to collect the randomized controlled trials (RCT) of sacubitril valsartan in the treatment of hypertension. The retrieval time was from the establishment of the data base to Nov. 30th, 2021. Two investigators independently performed literature screening, data extraction and bias risk assessment. Review Manager 5. 4 was used for data synthesis. RESULTS: A total of 14 RCT (15 articles) were enrolled, including 11 428 patients with hypertension. The control drug was angiotensin Ⅱ receptor blocker in 13 studies and amlodipine in 1 study; most studies used the daily dose of sacubitril valsartan for 400 mg; and 9 studies had a follow-up of ≤8 weeks. Compared with the control group (valsartan, olmersartan and amlodipine), sacubitril valsartan significantly reduced mean sitting systolic, diastolic blood pressure, mean ambulatory systolic and diastolic blood pressure, and significantly increased the rate of blood pressure control without increasing the risk of adverse events. CONCLUSIONS: Sacubitril valsartan may be more effective than conventional therapy in reducing blood pressure in patients with hypertensive without significantly increasing the incidence of adverse events. More clinical studies are still needed in the future to investigate the effects of age, gender, race and different population characteristics on the antihypertensive effect of sakubatril valsartan and to observe its long-term adverse effects. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To systematically review the comparison of efficacy between sacubitril valsartan and renin-angiotensin-aldosterone system ( RAAS) blockers in the treatment of heart failure complicated with renal insufficiency. METHODS: Randomized controlled trials of sakubatril valsartan (research group) versus RASS blockers (control group) in the treatment of heart failure complicated with renal insufficiency were systematically retrieved from 8 electronic databases until May 28, 2021, the quality of included literature were assessed by using the risk of bias measure tool recommended by the Cochrane Handbook, and Meta-analysis was conducted by using RevMan 5. 3 software. RESULTS: A total of 8 randomized controlled trials (including 3 575 patients) were involved. Results of the analysis showed that patients in the research group had significantly better effective rate of heart failure than that of the control group (RR = 1. 16,95%CI = 1. 07-1. 26,P = 0. 000 2), the research group had more significantly improved glomerular filtration rate (MD =3. 09,95%CI =1. 46-4. 73,P =0. 000 2), amino-terminal pro-brain natriuretic peptide (MD =-309. 93,95%CI =-556. 77--63. 10,P =0. 01), left ventricular ejection fraction (MD =4. 51,95%CI =3. 69- 5. 34,P<0. 000 01), left ventricular end-systolic diameter (MD =-4. 75,95%CI =-5. 63--3. 86,P<0. 000 01) and left ventricular end-diastolic diameter (MD = -5. 02,95%CI = -6. 32--3. 72,P<0. 000 01) than those of the control group, with statistically significant differences. CONCLUSIONS: The cardiorenal protective effect of sakubatril valsartan in patients with heart failure complicated with renal insufficiency may be superior to that of RAAS blockers. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) remodelling is a major mechanism underlying disease progression in patients with heart failure (HF) with reduced ejection fraction (EF). Previous studies that LVEF improvement and reverse remodelling can be achieved after therapy with Sacubitril/Valsartan in real-world settings. Therefore, we sought to investigate possible predictors of LV remodelling, in particular echocardiographic parameters derived by Tissue Doppler Imaging. Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II–III were followed up between September 2016 and January 2019. All patients underwent clinical and echocardiography follow up at baseline and after 12 months of therapy with sacubitril/valsartan. Fifty-four consecutive outpatients were enrolled in the study. At follow-up visit LVEF (38 ± 9 vs. 30 ± 5%, p < 0.0001), LVEDD (61 ± 8 vs. 62 ± 8 mm, p = 0.0085), LVESV (114 ± 57 vs. 130 ± 56 mm3, p = 0.0001), mitral regurgitation severity (1 ± 1 vs. 2 ± 1, p < 0.0001), and left atrial area (23 ± 6 vs. 24 ± 6 mm2, p = 0.0121) changed compared to the baseline value. Changes in LVEF (follow up vs baseline) correlated with baseline levels of heart rate (r = 0.24, p = 0.048), LVEDD (r= −0.33, p = 0.004), LVEDV (r= −0.39, p = 0.001), LVESV (r = 0.37, p = 0.002), and changes in LVESV (r=−0.34, p = 0.006). Correlations remained significant even after correction at multivariate analysis including age and gender. Treatment with sacubitril/valsartan in patients with systolic dysfunction is associated with an improvement in LVEF in a real world scenario. Smaller LV volumes are associated with better reverse LV remodelling. [ABSTRACT FROM AUTHOR]

Aim: The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. [ABSTRACT FROM AUTHOR]

Aim: The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. [ABSTRACT FROM AUTHOR]

Background: Despite coronary re-vascularization, the common complications of acute myocardial infarction (AMI), cardiac remodeling, and heart failure (HF), is increasing globally. Sacubitril valsartan (SV), an angiotensin receptor-neprilysin inhibitor (ARNI), has been previously demonstrated to improve HF. We further hypothesize that ultra-early SV treatment is also effective in preventing cardiac remodeling for patients with AMI following primary percutaneous coronary intervention (PCI). Methods: The Assessment of ultra-early administration of Sacubitril Valsartan to improve cardiac remodeling in patients with Acute Myocardial Infarction following primary PCI (ASV-AMI) trial is a prospective, multicenter, randomized controlled trial in China planning to enroll at least 1,942 eligible patients from 10 centers. After successful primary PCI of culprit artery within 24 h, AMI patients are randomized to 2 h group or 3–7 days group with SV treatment. The major endpoints are echocardiographic measurement, cardiothoracic ratio, and N-Terminal pro-B-Type Natriuretic Peptide (NT pro-BNP) at baseline, 1, 3, 6, and 12 months. The secondary endpoints included MACE (cardiac arrest, cardiogenic death, myocardial infarction, and target vessel re-vascularization), in-/out-patient HF, EuroQol Five Dimensions Questionnaire (EQ-5D), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Discussion: The ASV-AMI trial is the first clinical trial of ultra-early administration of SV in the treatment of post-PCI AMI, adding more clinical evidence. Early application of SV to prevent cardiac remodeling in AMI patient is a major focus of this trial. Clinical Trial Registration: Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn; ChiCTR2100051979). Registered on 11 October 2021. [ABSTRACT FROM AUTHOR]

Joseph J Cuthbert,1 Pierpaolo Pellicori,2 Andrew L Clark1 1Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Kingston upon Hull HU16 5JQ, UK; 2Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UKCorrespondence: Joseph J CuthbertDepartment of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UKTel + 44 (0)1482 461776Fax + 44 (0)1482 461779Email joe.cuthbert@hey.nhs.ukAbstract: One of the defining features of heart failure (HF) is neurohormonal activation. The renin-angiotensin-aldosterone-system (RAAS) and sympathetic nervous system (SNS) cause vasoconstriction and fluid retention and, in response, the secretion of natriuretic peptides (NPs) from volume and pressure-overloaded myocardium promotes vasodilation and diuresis. Inhibition of the RAAS with either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) has been the cornerstone of medical treatment for HF with a reduced ejection fraction (HFrEF) but, until recently, it was unclear how the beneficial effects of NPs may be augmented in patients with HF. Neprilysin, a metalloproteinase widely distributed throughout the body, plays a role in degrading the gross excess of circulating NPs in patients with HF. Early studies of neprilysin inhibition suggested possible physiological benefits. In 2014, the PARADIGM-HF trial found that sacubitril-valsartan, a combination of the ARB valsartan, and the neprilysin inhibitor sacubitril, was superior to enalapril in patients with HFrEF, reducing the relative risk of cardiovascular (CV) death or first hospitalisation with HF by 20%. Almost half of the patients with HF symptoms have a “preserved” ejection fraction (HFpEF); however, the PARAGON-HF study found that sacubitril-valsartan in patients with LVEF ≥ 45% had no effect on CV death or first and recurrent hospitalisations with HF compared to valsartan. Guidelines across the world have changed to include sacubitril-valsartan for patients with HFrEF yet, nearly 6 years after PARADIGM-HF, there is still uncertainty as to when and in whom sacubitril-valsartan should be started. Furthermore, there may yet be subsets of patients with HFpEF who might benefit from treatment with sacubitril-valsartan. This review will describe the mechanisms behind the outcome benefit of sacubitril-valsartan in patients with HFrEF and to consider its future role in the management of patients with HF.Keywords: sacubitril-valsartan, heart failure, PARADIGM-HF, PARAGON-HF, natriuretic peptide, angiotensin receptor neprilysin inhibitor

BackgroundDespite coronary re-vascularization, the common complications of acute myocardial infarction (AMI), cardiac remodeling, and heart failure (HF), is increasing globally. Sacubitril valsartan (SV), an angiotensin receptor-neprilysin inhibitor (ARNI), has been previously demonstrated to improve HF. We further hypothesize that ultra-early SV treatment is also effective in preventing cardiac remodeling for patients with AMI following primary percutaneous coronary intervention (PCI).MethodsThe Assessment of ultra-early administration of Sacubitril Valsartan to improve cardiac remodeling in patients with Acute Myocardial Infarction following primary PCI (ASV-AMI) trial is a prospective, multicenter, randomized controlled trial in China planning to enroll at least 1,942 eligible patients from 10 centers. After successful primary PCI of culprit artery within 24 h, AMI patients are randomized to 2 h group or 3–7 days group with SV treatment. The major endpoints are echocardiographic measurement, cardiothoracic ratio, and N-Terminal pro-B-Type Natriuretic Peptide (NT pro-BNP) at baseline, 1, 3, 6, and 12 months. The secondary endpoints included MACE (cardiac arrest, cardiogenic death, myocardial infarction, and target vessel re-vascularization), in-/out-patient HF, EuroQol Five Dimensions Questionnaire (EQ-5D), and Kansas City Cardiomyopathy Questionnaire (KCCQ).DiscussionThe ASV-AMI trial is the first clinical trial of ultra-early administration of SV in the treatment of post-PCI AMI, adding more clinical evidence. Early application of SV to prevent cardiac remodeling in AMI patient is a major focus of this trial.Clinical Trial RegistrationTrial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn; ChiCTR2100051979). Registered on 11 October 2021.

Background: Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real‐world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging. Methods: Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II‐III were followed up for 6 months after therapy with S/V. LV&RV function was assessed at baseline and after 6 months of therapy. Results: After 6‐month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP (31 ± 11 vs. 35 ± 10 mmHg, p < 0.001), TAPSE (19 ± 3 vs. 18 ± 3 mm, p < 0.001), RV FAC (38 ± 7 vs. 34 ± 6 mm, p < 0.001), RV S' (12 ± 2 vs. 10 ± 2 cm/s, p < 0.001), RV‐FW‐LS (−20 ± 5 vs. −18 ± 5%, p < 0.001), RV‐4Ch‐LS (−16 ± 5 vs. −14 ± 5%, p < 0.001). At multivariable analysis improvement in RV‐FW‐LS was associated to baseline levels of RV S' (r 0.75, p < 0.01) and RAV (r –0.32, p < 0.05). Conclusions: In a real‐world scenario, 6‐month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S' and right atrial volume values. [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]

OBJECTIVE: To compare the efficacy and safety of Sacubitril valsartan sodium tablets and Benazepril hydrochloride tablets in the treatment of chronic heart failure with reduced ejection fraction, so as to explore effective medication regimens for clinical treatment. METHODS: Totally 102 chronic heart failure with reduced ejection fraction patients admitted into Changshu No. 2 People's Hospital from Dec. 2018 to Dec. 2019 were extracted to be divided into the ARNI group and the ACEI group via the random number table and opaque envelope method, with 51 cases in each group. Patients in the ARNI group received Sacubitril valsartan sodium tablets, while the ACEI group was given Benazepril hydrochloride tablets. Clinical efficacy, cardiac function indicators [left ventricular posterior wall thickness (LVPWD), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular global longitudinal strain (GLS), radial strain (GRS) and circumferential strain (GCS) during diastole], myocardial injury markers [N-terminal precursor brain natriuretic peptide (NT-ProBNP), serum troponin I (cTn I)], inflammatory mediators and myocardial fibrosis markers [soluble growth stimulating expression gene 2 protein (sST2) levels, interleukin (IL)-1 and IL-6] before and after treatment, adverse drug reactions during medication in two groups were observed and compared. RESULTS: The total effective rate in the ARNI group was 90. 20% (46 / 51), significantly higher than that in the ACEI group (74. 51%,38 / 51), with statistically significant difference (P<0. 05). After treatment, the absolute values of LVEF, GLS and GCS of all patients were significantly higher than those before treatment, and LVPWD, LVEDD, NT-ProBNP, cTnⅠ, IL-1, IL-6 and sST2 were significantly lower than those before treatment; meanwhile, the increase of LVEF in the ARNI group was greater, and the decrease of LVPWD, LVEDD, NT-proBNP, IL-1, IL-6, cTnⅠ and SST2 was greater, with statistically significant difference (P<0. 05). After 12 months of follow-up, 1 patient developed hypotension, 1 patient developed cough, and 1 patient was readmitted to hospital, but no hyperkalemia or death was observed in the ARNI group. In the ACEI group, 1 patient developed hypotension, 1 patient developed cough, 4 patients were readmitted to hospital, and 1 patient death, but no hyperkalemia was observed. CONCLUSIONS: Compared with Benazepril hydrochloride tablets, Sacubitril valsartan sodium tablets are more effective in improving heart function, inflammatory factors and myocardial injury markers in chronic heart failure with reduced ejection fraction patients, with better clinical efficacy and similar safety. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the present study was to observe the effect of sacubitril valsartan on cardiac function and vascular endothelial function in patients with chronic heart failure with reduced ejection fraction (HFrEF). METHODS: A total of 80 patients with HFrEF were randomly divided into an observation group and a control group, with 40 patients in each group. Sacubitril valsartan was added to the conventional treatment in the observation group, and perindopril was added to the conventional treatment in the control group. Both groups were treated continuously for 12 weeks. The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), flow-mediated vasodilatory function (FMD) of the brachial artery, and levels of plasma Ang II, endothelin 1 (ET-1), and calcitonin gene-related peptide (CGRP), together with the serum nitric oxide (NO) and NO synthase (NOS) were compared before and after treatment in the groups. RESULTS: Before the treatment, the levels of LVEF, LVEDD, FMD, Ang II, ET-1, CGRP, NO, and NOS in the observation group were not significantly different from those in the control group (P > 0.05). However, the levels of LVEF, FMD, CGRP, NO, and NOS in both groups were significantly higher after the treatment than those before the treatment (P < 0.05) and significantly higher in the observation group than those in the control group. The difference was statistically significant (P < 0.05). Meanwhile, the levels of LVEDD, Ang II, and ET-1 in both groups decreased significantly after the treatment (P < 0.05) and were significantly lower in the observation group than those in the control group. The difference was statistically significant (P < 0.05). CONCLUSION: Sacubitril valsartan might improve endothelial function while increasing cardiac function in HFrEF patients. [ABSTRACT FROM AUTHOR]

Aim: Sacubitril valsartan (SV) has revolutionized disease history in patients with heart failure and reduced ejection fraction (HFrEF). Our study assessed SV impact on clinical and echocardiographic parameters in HFrEF outpatients previously treated with optimized therapy. Methods: Forty-nine HFrEF outpatients were retrospectively included in the study. We collected data from transthoracic echocardiography and clinical assessment at baseline and after 3 ± 1 and 12 ± 1 months of treatment with SV. Results were also stratified by sex to analyse possible sex-based differences in reverse remodelling response to SV. Results: After 3 months of treatment we observed a significative improvement of both systolic and diastolic function with a reduction of left ventricular mass and relative wall thickness (RWT). At 12 months we observed a further improvement of all previous parameters, plus systolic pulmonary artery pressure (PAP) and left atrial (LA) diameter. In women, most of the echocardiographic parameters improved after SV initiation, but did not reach the statistical significance, except for left ventricular ejection fraction (LVEF), PAP and LA diameter. As for clinical parameters, SV improved New York Heart Association (NYHA) Class, systolic blood pressure and loop diuretic dosage with a mild but significative increase in serum creatinine and potassium. Conclusion: Our study showed significative reverse remodelling properties of SV with an improvement of LV volumes, mass and systo-diastolic function. NYHA Class, systolic blood pressure and loop diuretic dosage also improved with only mild increase in serum creatinine and potassium. Women showed a lesser extent of reverse remodelling compared with men.

Objective: To observe the clinical efficacy of sacubitril and valsartan sodium tablets combined with low-dose metoprolol in the treatment of middle-aged and young people with hypertension. Methods: A total of 92 young and middle-aged hypertensive patients admitted between December 2018 and December 2019 were selected and divided into experimental group and control group by random number table method, each with 46 cases. The control group orally took sacubitril and valsartan sodium tablets, 50 mg/time, 2 times/d; the test group took the same dose of sacubitril and valsartan sodium tablets and added a small dose of metoprolol 12.5 mg/time, 2 times/d, the medication time of both groups was 8 weeks. After the treatment, compare the changes of systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the two groups before and after the test, discuss the effectiveness of the two treatment methods, and record the occurrence of adverse reactions. Results: (1) The systolic blood pressure and diastolic blood pressure of the experimental group and the control group were significantly lower than before the treatment (P<0.05); (2) After the treatment, the systolic blood pressure and diastolic blood pressure of the experimental group were significantly lower than those of the control group (P<0.05); (3) The total effective rate in the experimental group was 97.83%, which was higher than 73.91% in the control group (P<0.05); (4) The incidence of adverse reactions in the two groups was 8.68% in the experimental group and 6.51% in the control group, No statistical difference (P>0.05). Conclusion: The use of sacubitril and valsartan combined with low-dose metoprolol in the treatment of hypertension in the young and middle-aged has a more obvious clinical advantage than taking sacubitril and valsartan alone. It is recommended to promote it. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of Levosimendan combined with Sacubitril Valsartan on hemodynamics and exercise capacity in chronic heart failure patients. Methods: From January 2018 to May 2019, 80 patients with chronic heart failure who were diagnosed and treated in in the Department of Cardiology of our hospital were enrolled and were divided into the combination group (50 cases) and the control group (30 cases) accorded to the random number table method. After the two groups were admitted routine treatment, on the basis of this, the control group was treated with Sacubitril Valsartan, the combination group was treated with Levosimendan combined with Sacubitril Valsartan. The two groups were treated for 1 month, and the changes of hemodynamics and exercise capacity were recorded. Results: The total effective rate of the combination group after treatment was significantly higher than that of the control group (98.0% vs 80.0%, P<0.05). There were no significant differences in the values of left ventricular ejection fraction (LVEF) and (Left ventricular end-systolic diameter, LVSD) between the two groups (P>0.05). After 1 month of treatment, the LVEF values of the two groups after treatment were significantly higher, and the LVSD values were significantly lower (P<0.05), and the change of the above indicators was more significant in the combination group (P<0.05). The 6-minute walking distance after treatment were significantly higher than that before treatment (P<0.05), and the combination group were also significantly higher than the control group (P<0.05). Conclusion: Levosimendan combined with Sacubitril Valsartan in the treatment of chronic heart failure can improve the hemodynamics and exercise capacity of patients, and thus improve the therapeutic effect [ABSTRACT FROM AUTHOR]

CRC is a common but serious complication or sequela of tumor treatment, and new coping strategies are urgently needed. SV is a classic clinical cardiovascular protective drug, which has been widely used in the treatment of heart failure, hypertension and other diseases. It has good therapeutic effect in other cardiovascular diseases such as diabetes cardiomyopathy, ischemic cardiomyopathy and vascular disease, but it has not been proved by research that SV can prevent and treat CRC. In this study, DOX was used to induce a rat CRC model and evaluate the therapeutic effect of SV on it. Subsequently, R software was applied to analyze the control group, SV group, and DOX group in databases GSE207283 and GSE22369, and to screen for common differentially expressed genes. Use the DAVID website for enrichment analysis and visualization. Use STRING website to analyze and visualize protein interaction networks of key genes. Finally, experimental verification was conducted on key genes. Our research results show that SV has a protective effect on DOX induced myocardial injury by alleviating Weight loss, increasing Ejection fraction, and reducing the level of biomarkers of myocardial injury. Meanwhile, SV can effectively alleviate the above abnormalities. Bioinformatics and KEGG pathway analysis showed significant enrichment of metabolic and MAPK signaling pathways, suggesting that they may be the main regulatory pathway for SV treatment of CRC. Subsequent studies have also confirmed that SV can inhibit DOX induced myocardial injury through the MAPK signaling pathway, and alleviate DOX induced oxidative stress and inflammatory states. Our research indicates that SV is a potential drug for treating CRC and preliminarily elucidates its molecular mechanism of regulating the MAPK pathway to improve oxidative stress and inflammation. • This study proposes for the first time that Sacubitril Valsartan (SV) can be used as a therapeutic drug for chemotherapy related cardiotoxicity. • This study analyzed and validated through bioinformatics methods that SV effectively improves inflammation and oxidative stress related to DOX induced cardiotoxicity by regulating the MAPK signaling pathway. [ABSTRACT FROM AUTHOR]

Heart failure is a condition with high morbidity and mortality. Pharmacological treatment has greatly contributed to improved outcomes and experiences of people living with heart failure. A new agent, sacubitril valsartan, has been approved for patients with heart failure and reduced ejection fraction. This article discusses the evidence base, mechanism of action, clinical indications and practical considerations for the use of sacubitril valsartan in practice. [ABSTRACT FROM AUTHOR]