Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy
Abstract Background Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but th...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Cardio-Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40959-020-00078-4 |
| _version_ | 1818259430342393856 |
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| author | Vanesa Gregorietti Teresa Lopez Fernandez Diego Costa Elías Ortega Chahla Andrés J. Daniele |
| author_facet | Vanesa Gregorietti Teresa Lopez Fernandez Diego Costa Elías Ortega Chahla Andrés J. Daniele |
| author_sort | Vanesa Gregorietti |
| collection | DOAJ |
| description | Abstract Background Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but there is no well-established evidence on how sacubitril/valsartan may help cancer patients with cardiotoxicity. Objectives The aim of this trial was to study the effectiveness of sacubitril-valsartan in patients with CTRCD treated in cardio-oncology units. Methods We enrolled 635 patients with breast cancer and followed them with echocardiography and NT- proBNP. Patients who developed left ventricular dysfunction and heart failure were treated with angiotensin-converting enzyme inhibitors (ACEI) (enalapril) or angiotensin receptor blockers (ARB) (valsartan), aldosterone antagonists (eplerenone), digitalis and diuretics (furosemide), as needed. When patients remained symptomatic and met the PARADIGM-HF inclusion criteria, sacubitril/valsartan was started instead of enalapril or valsartan. We analyzed clinical, laboratory and echocardiographic variables to determine the beneficial effects of sacubitril/valsartan on left ventricular remodeling (improvement of left ventricular ejection fraction (LVEF), left ventricle internal diameter in diastole), diastolic dysfunction (E/e’ ratio), reduction in NT-proBNP levels, New York Heart Association (NHYA) class and improvement in the 6-min walk test. Also, we analyzed serum creatinine and potassium levels to determine treatmentsafety in this population. Median follow-up was 20 months. Results Twenty-eight patients developed cardiotoxicity and were treated with sacubitril/valsartan. The sacubitril/valsartan dose was 100 mg (sacubitril 49 mg/valsartan 51 mg) in 12 patients (42.85%) and 200 mg (sacubitril 97 mg/valsartan 103 mg) in 16 patients (57.15%). No deaths were reported, and one patient underwent heart transplantation. Baseline median NT-proBNP was 997.5 pg/ml (IQR 663.8 — 2380.8), which decreased to a median of 416.5 pg/ml (IQR 192.0–798.2) on follow-up with p < 0.001. Baseline NYHA functional class was III (78.6%) or IV (21.4%), and it improved to I (57.1%) or II (42.9%) on follow-up. LVEF increased with treatment from 26.7 ± 5.4% to 32.3 ± 5.5% (p < 0.001). There were also significant improvements in left ventricle internal diameter in diastole (LVIDD), diastolic function, 6-min walk test, and mitral valve regurgitation. There were no differences between basal and follow-up levels of serum creatinine or potassium. Conclusion Sacubitril/valsartan might be a promising treatment option in patients with refractory CTRCD. |
| first_indexed | 2024-12-12T18:15:19Z |
| format | Article |
| id | doaj.art-cfeae522a97f4f49a503296dba2e7b7e |
| institution | Directory Open Access Journal |
| issn | 2057-3804 |
| language | English |
| last_indexed | 2024-12-12T18:15:19Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardio-Oncology |
| spelling | doaj.art-cfeae522a97f4f49a503296dba2e7b7e2022-12-22T00:16:17ZengBMCCardio-Oncology2057-38042020-11-01611610.1186/s40959-020-00078-4Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapyVanesa Gregorietti0Teresa Lopez Fernandez1Diego Costa2Elías Ortega Chahla3Andrés J. Daniele4Cardio-Oncology Department, Roffo InstituteCardiology Department, La Paz University HospitalCardio-Oncology Department, Roffo InstituteCardio-Oncology Department, Roffo InstituteCardio-Oncology Department, Roffo InstituteAbstract Background Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but there is no well-established evidence on how sacubitril/valsartan may help cancer patients with cardiotoxicity. Objectives The aim of this trial was to study the effectiveness of sacubitril-valsartan in patients with CTRCD treated in cardio-oncology units. Methods We enrolled 635 patients with breast cancer and followed them with echocardiography and NT- proBNP. Patients who developed left ventricular dysfunction and heart failure were treated with angiotensin-converting enzyme inhibitors (ACEI) (enalapril) or angiotensin receptor blockers (ARB) (valsartan), aldosterone antagonists (eplerenone), digitalis and diuretics (furosemide), as needed. When patients remained symptomatic and met the PARADIGM-HF inclusion criteria, sacubitril/valsartan was started instead of enalapril or valsartan. We analyzed clinical, laboratory and echocardiographic variables to determine the beneficial effects of sacubitril/valsartan on left ventricular remodeling (improvement of left ventricular ejection fraction (LVEF), left ventricle internal diameter in diastole), diastolic dysfunction (E/e’ ratio), reduction in NT-proBNP levels, New York Heart Association (NHYA) class and improvement in the 6-min walk test. Also, we analyzed serum creatinine and potassium levels to determine treatmentsafety in this population. Median follow-up was 20 months. Results Twenty-eight patients developed cardiotoxicity and were treated with sacubitril/valsartan. The sacubitril/valsartan dose was 100 mg (sacubitril 49 mg/valsartan 51 mg) in 12 patients (42.85%) and 200 mg (sacubitril 97 mg/valsartan 103 mg) in 16 patients (57.15%). No deaths were reported, and one patient underwent heart transplantation. Baseline median NT-proBNP was 997.5 pg/ml (IQR 663.8 — 2380.8), which decreased to a median of 416.5 pg/ml (IQR 192.0–798.2) on follow-up with p < 0.001. Baseline NYHA functional class was III (78.6%) or IV (21.4%), and it improved to I (57.1%) or II (42.9%) on follow-up. LVEF increased with treatment from 26.7 ± 5.4% to 32.3 ± 5.5% (p < 0.001). There were also significant improvements in left ventricle internal diameter in diastole (LVIDD), diastolic function, 6-min walk test, and mitral valve regurgitation. There were no differences between basal and follow-up levels of serum creatinine or potassium. Conclusion Sacubitril/valsartan might be a promising treatment option in patients with refractory CTRCD.http://link.springer.com/article/10.1186/s40959-020-00078-4Heart failureCancerCardiotoxicitySacubitril/valsartan |
| spellingShingle | Vanesa Gregorietti Teresa Lopez Fernandez Diego Costa Elías Ortega Chahla Andrés J. Daniele Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy Cardio-Oncology Heart failure Cancer Cardiotoxicity Sacubitril/valsartan |
| title | Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| title_full | Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| title_fullStr | Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| title_full_unstemmed | Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| title_short | Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| title_sort | use of sacubitril valsartan in patients with cardio toxicity and heart failure due to chemotherapy |
| topic | Heart failure Cancer Cardiotoxicity Sacubitril/valsartan |
| url | http://link.springer.com/article/10.1186/s40959-020-00078-4 |
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