Sacubitril/valsartan improves ejection fraction in heart failure with reduced ejection fraction: A retrospective study
Walid Ibrahim1, Ahmed S Yassin1, Ahmed Subahi1, Hassan Mohamed2, Ayman Khaddam2, Muhammad Bajwa3, Ashraf Abugroun4, Amir Kaki5, Mahir Elder5, Tamam Mohamad5
1 Department of Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, MI, USA
2 Hearts and Vascular Institute, Detroit Medical Center, Detroit, MI, USA
3 University of Oklahoma Health Science Center, Oklahoma City, OK, USA
4 Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
5 Department of Cardiovascular Medicine-CCU, Wayne State University, Detroit Medical Center, Detroit, MI, USA
Department of Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, MI
Source of Support: None, Conflict of Interest: None
Background and objectives: The discovery and introduction of Neprilysin inhibitor in treating chronic heart failure (New York Heart Association class II–IV) with reduced ejection fraction (HFrEF) is a remarkable landmark in therapy. The clinical outcome of reducing the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure was demonstrated at the large randomized, double blind, “Angiotensin-Neprilysin inhibition versus enalapril in heart failure (PARADIGM-HF trial).” We studied a total of 228 patients with HFrEF who was recently started on sacubitril/valsartan (EntrestoTM; previously known as LCZ696) testing the hypothesis of improving ejection fraction with sacubitril/valsartan, defined as an increase of ejection fraction from the baseline before treatment by 10–15%.
Methods: This is a single-center, retrospective, descriptive study. The data was collected from the charts of patients followed up for a mean of 4.7 weeks after initiation of treatment with sacubitril/valsartan. A total of 228 patients with heart failure were prescribed 200 mg of sacubitril/valsartan twice daily, an improvement in ejection fraction by 10–15% was considered a successful response.
Results: Out of the 228 patients, 51.3% showed a successful response. Most of the patients 97.9% and 58.0% were taking beta-blockers and aspirin respectively. The absolute number of black patients who improved was higher than others ethnic groups. However, the higher percentage of ejection fraction improvement 71% was reported among other ethnicities (not blacks or Caucasians). Patients without episodes of hospitalization showed better improvement than those with one or more episodes.
Conclusion: In a predominantly black population with HFrEF, sacubitril/valsartan has shown improvement in ejection fraction effect. This finding was independent of other risk factors and concomitant heart failure treatment; however, further studies are recommended to validate this result.
Ethics: Ethical approval of this study was obtained from the Research Committee, DMC/Wayne State University (IRB# 015618MP4X) on February 14, 2018.