Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction
Abstract Background We examined the effect of switching from angiotensin receptor-neprilysin inhibitor (ARNI) to angiotensin-receptor blocker (ARB) on plasma levels of natriuretic peptides and myocardial remodeling. Methods This is a prospective study that included 11 patients with heart failure (HF...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-023-03077-2 |
| _version_ | 1797946108523053056 |
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| author | Akihiro Nakamura Yuta Kagaya Hiroki Saito Masanori Kanazawa Masanobu Miura Masateru Kondo Kenjiro Sato Hideaki Endo |
| author_facet | Akihiro Nakamura Yuta Kagaya Hiroki Saito Masanori Kanazawa Masanobu Miura Masateru Kondo Kenjiro Sato Hideaki Endo |
| author_sort | Akihiro Nakamura |
| collection | DOAJ |
| description | Abstract Background We examined the effect of switching from angiotensin receptor-neprilysin inhibitor (ARNI) to angiotensin-receptor blocker (ARB) on plasma levels of natriuretic peptides and myocardial remodeling. Methods This is a prospective study that included 11 patients with heart failure (HF) treated with ARNI. The patients were divided into two groups: 5 patients who continued treatment with sacubitril/valsartan 194/206 mg/day (ARNI-continue group) and 6 patients who were switched to valsartan 160 mg/day (ARB-switch group). The primary endpoint was percent change (%Change) in plasma A-, B-, and N-terminal pro-B-type natriuretic peptide (ANP, BNP, and NT-proBNP) levels from the baseline to week 24. The secondary endpoint was the change in echocardiographic parameters related to myocardial remodeling from the baseline to week 24. Results ANP levels in the ARB-switch group significantly decreased (from 1155.7 ± 592.6 pg/mL to 231.6 ± 233.8 pg/mL, p = 0.035), whereas those in the ARNI-continue group were not significant (p = 0.180). The %Change of decrease in ANP levels was significantly greater in the ARB-switch group than the ARNI-continue group (− 76.9% vs. −9.1%, p = 0.009). BNP levels were not significantly different between the baseline and week 24 in both groups. NT-proBNP levels in the ARB-switch group increased from 1185.3 ± 835.6 pg/mL to 1515.2 ± 1213.5 pg/mL, although the changes were not statistically significant (p = 0.345). The %Change of increase in NT-proBNP levels was significantly greater in the ARB-switch group than the ARNI-continue group (57.9% vs. 17.3%, p = 0.016). In the ARB-switch group, there was a significant increase in left ventricular (LV) end-systolic volume (from 41.3 ± 24.1 mL/m2 to 71.4 ± 8.8 mL/m2, p = 0.043) and LV peak-systolic wall stress (from 187.0 ± 42.7 × 103 dynes/cm2 to 279.7 ± 34.1 × 103 dynes/cm2, p = 0.012) from the baseline to week 24 and a trend toward a decrease in LV ejection fraction (p = 0.080). In the ARNI-continue group, no differences in echocardiographic parameters were observed from the baseline to week 24. Conclusion Switching from ARNI to ARB may worsen HF due to returning to myocardial remodeling induced by a sustained decline in ANP levels. |
| first_indexed | 2024-04-10T21:05:40Z |
| format | Article |
| id | doaj.art-b5de002f6a8049b19c52d8905c98dd8b |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-04-10T21:05:40Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-b5de002f6a8049b19c52d8905c98dd8b2023-01-22T12:04:13ZengBMCBMC Cardiovascular Disorders1471-22612023-01-012311910.1186/s12872-023-03077-2Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fractionAkihiro Nakamura0Yuta Kagaya1Hiroki Saito2Masanori Kanazawa3Masanobu Miura4Masateru Kondo5Kenjiro Sato6Hideaki Endo7Department of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalDepartment of Cardiology, Iwate Prefectural Central HospitalAbstract Background We examined the effect of switching from angiotensin receptor-neprilysin inhibitor (ARNI) to angiotensin-receptor blocker (ARB) on plasma levels of natriuretic peptides and myocardial remodeling. Methods This is a prospective study that included 11 patients with heart failure (HF) treated with ARNI. The patients were divided into two groups: 5 patients who continued treatment with sacubitril/valsartan 194/206 mg/day (ARNI-continue group) and 6 patients who were switched to valsartan 160 mg/day (ARB-switch group). The primary endpoint was percent change (%Change) in plasma A-, B-, and N-terminal pro-B-type natriuretic peptide (ANP, BNP, and NT-proBNP) levels from the baseline to week 24. The secondary endpoint was the change in echocardiographic parameters related to myocardial remodeling from the baseline to week 24. Results ANP levels in the ARB-switch group significantly decreased (from 1155.7 ± 592.6 pg/mL to 231.6 ± 233.8 pg/mL, p = 0.035), whereas those in the ARNI-continue group were not significant (p = 0.180). The %Change of decrease in ANP levels was significantly greater in the ARB-switch group than the ARNI-continue group (− 76.9% vs. −9.1%, p = 0.009). BNP levels were not significantly different between the baseline and week 24 in both groups. NT-proBNP levels in the ARB-switch group increased from 1185.3 ± 835.6 pg/mL to 1515.2 ± 1213.5 pg/mL, although the changes were not statistically significant (p = 0.345). The %Change of increase in NT-proBNP levels was significantly greater in the ARB-switch group than the ARNI-continue group (57.9% vs. 17.3%, p = 0.016). In the ARB-switch group, there was a significant increase in left ventricular (LV) end-systolic volume (from 41.3 ± 24.1 mL/m2 to 71.4 ± 8.8 mL/m2, p = 0.043) and LV peak-systolic wall stress (from 187.0 ± 42.7 × 103 dynes/cm2 to 279.7 ± 34.1 × 103 dynes/cm2, p = 0.012) from the baseline to week 24 and a trend toward a decrease in LV ejection fraction (p = 0.080). In the ARNI-continue group, no differences in echocardiographic parameters were observed from the baseline to week 24. Conclusion Switching from ARNI to ARB may worsen HF due to returning to myocardial remodeling induced by a sustained decline in ANP levels.https://doi.org/10.1186/s12872-023-03077-2Angiotensin-receptor blockerAngiotensin receptor-neprilysin inhibitorMyocardial remodelingNatriuretic peptideWall stress |
| spellingShingle | Akihiro Nakamura Yuta Kagaya Hiroki Saito Masanori Kanazawa Masanobu Miura Masateru Kondo Kenjiro Sato Hideaki Endo Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction BMC Cardiovascular Disorders Angiotensin-receptor blocker Angiotensin receptor-neprilysin inhibitor Myocardial remodeling Natriuretic peptide Wall stress |
| title | Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| title_full | Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| title_fullStr | Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| title_full_unstemmed | Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| title_short | Effects of switching from sacubitril/valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| title_sort | effects of switching from sacubitril valsartan to valsartan alone on plasma levels of natriuretic peptides and myocardial remodeling in heart failure with reduced ejection fraction |
| topic | Angiotensin-receptor blocker Angiotensin receptor-neprilysin inhibitor Myocardial remodeling Natriuretic peptide Wall stress |
| url | https://doi.org/10.1186/s12872-023-03077-2 |
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