Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis
BackgroundEffects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a gr...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.883769/full |
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| author | Sara Monosilio Domenico Filomena Federico Luongo Michele Sannino Sara Cimino Matteo Neccia Marco Valerio Mariani Lucia Ilaria Birtolo Giulia Benedetti Giovanni Tonti Gianni Pedrizzetti Carmine Dario Vizza Viviana Maestrini Luciano Agati |
| author_facet | Sara Monosilio Domenico Filomena Federico Luongo Michele Sannino Sara Cimino Matteo Neccia Marco Valerio Mariani Lucia Ilaria Birtolo Giulia Benedetti Giovanni Tonti Gianni Pedrizzetti Carmine Dario Vizza Viviana Maestrini Luciano Agati |
| author_sort | Sara Monosilio |
| collection | DOAJ |
| description | BackgroundEffects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients undergoing S/V therapy.MethodsFifty HFrEF patients eligible to start a therapy with S/V were enrolled. Echocardiographic evaluation was performed at baseline and after 6 months of follow-up (FU). Beside standard evaluation, including global longitudinal strain (GLS), estimated hemodynamic forces (HDFs) and non-invasive pressure-volume curves (PV loop) were assessed using dedicated softwares. HDFs were evaluated over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). Parameters derived from estimated PV loop curves were left ventricular end-systolic elastance (Ees), arterial elastance (Ea), and ventricular-arterial coupling (VAC).ResultsAt 6 months of FU indexed left ventricular end-diastolic and end-systolic volumes decreased (EDVi: 101 ± 28 mL vs. 86 ± 30 mL, p < 0.001; ESVi: 72 ± 23 mL vs. 55 ± 24 mL, p < 0.001), ejection fraction and GLS significantly improved (EF: 29 ± 6% vs. 37 ± 7%, p < 0.001; GLS: −9 ± 3% vs. −13 ± 4%, p < 0.001). A reduction of Ea (2.11 ± 0.91 mmHg/mL vs. 1.72 ± 0.44 mmHg/mL, p = 0.008) and an improvement of Ees (1.01 ± 0.37 mmHg/mL vs. 1.35 ± 0.6 mmHg/mL, p < 0.001) and VAC (2.3 ± 1.1 vs. 1.5 ± 0.7, p < 0.001) were observed. Re-alignment of HDFs occurred, with a reduction of diastolic L-S/A-B HDFs ratio [23 (20–35)% vs. 20 (11–28) %, p < 0.001].ConclusionS/V therapy leads to a complex phenomenon of reverse remodeling involving increased myocardial contractility, HDFs distribution improvement, and afterload reduction. |
| first_indexed | 2024-12-12T05:33:14Z |
| format | Article |
| id | doaj.art-29951b339acd4f7e885e3c273532e0ed |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-12T05:33:14Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-29951b339acd4f7e885e3c273532e0ed2022-12-22T00:36:14ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-05-01910.3389/fcvm.2022.883769883769Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic AnalysisSara Monosilio0Domenico Filomena1Federico Luongo2Michele Sannino3Sara Cimino4Matteo Neccia5Marco Valerio Mariani6Lucia Ilaria Birtolo7Giulia Benedetti8Giovanni Tonti9Gianni Pedrizzetti10Carmine Dario Vizza11Viviana Maestrini12Luciano Agati13Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyCardiology Division, ‘G. D'Annunzio’ University, Chieti, ItalyDepartment of Engineering and Architecture, University of Trieste, Trieste, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyDepartment of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, ItalyBackgroundEffects of Sacubitril/Valsartan (S/V) on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients undergoing S/V therapy.MethodsFifty HFrEF patients eligible to start a therapy with S/V were enrolled. Echocardiographic evaluation was performed at baseline and after 6 months of follow-up (FU). Beside standard evaluation, including global longitudinal strain (GLS), estimated hemodynamic forces (HDFs) and non-invasive pressure-volume curves (PV loop) were assessed using dedicated softwares. HDFs were evaluated over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). Parameters derived from estimated PV loop curves were left ventricular end-systolic elastance (Ees), arterial elastance (Ea), and ventricular-arterial coupling (VAC).ResultsAt 6 months of FU indexed left ventricular end-diastolic and end-systolic volumes decreased (EDVi: 101 ± 28 mL vs. 86 ± 30 mL, p < 0.001; ESVi: 72 ± 23 mL vs. 55 ± 24 mL, p < 0.001), ejection fraction and GLS significantly improved (EF: 29 ± 6% vs. 37 ± 7%, p < 0.001; GLS: −9 ± 3% vs. −13 ± 4%, p < 0.001). A reduction of Ea (2.11 ± 0.91 mmHg/mL vs. 1.72 ± 0.44 mmHg/mL, p = 0.008) and an improvement of Ees (1.01 ± 0.37 mmHg/mL vs. 1.35 ± 0.6 mmHg/mL, p < 0.001) and VAC (2.3 ± 1.1 vs. 1.5 ± 0.7, p < 0.001) were observed. Re-alignment of HDFs occurred, with a reduction of diastolic L-S/A-B HDFs ratio [23 (20–35)% vs. 20 (11–28) %, p < 0.001].ConclusionS/V therapy leads to a complex phenomenon of reverse remodeling involving increased myocardial contractility, HDFs distribution improvement, and afterload reduction.https://www.frontiersin.org/articles/10.3389/fcvm.2022.883769/fullsacubitril/valsartanechocardiographyspeckle-trackinghemodynamic forcespressure-volume loop |
| spellingShingle | Sara Monosilio Domenico Filomena Federico Luongo Michele Sannino Sara Cimino Matteo Neccia Marco Valerio Mariani Lucia Ilaria Birtolo Giulia Benedetti Giovanni Tonti Gianni Pedrizzetti Carmine Dario Vizza Viviana Maestrini Luciano Agati Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis Frontiers in Cardiovascular Medicine sacubitril/valsartan echocardiography speckle-tracking hemodynamic forces pressure-volume loop |
| title | Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis |
| title_full | Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis |
| title_fullStr | Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis |
| title_full_unstemmed | Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis |
| title_short | Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis |
| title_sort | cardiac and vascular remodeling after 6 months of therapy with sacubitril valsartan mechanistic insights from advanced echocardiographic analysis |
| topic | sacubitril/valsartan echocardiography speckle-tracking hemodynamic forces pressure-volume loop |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.883769/full |
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