The Effect of Angiotensin Receptor Inhibitors and Neprilysin on Aortic Stiffness in Patients with Heart Failure and Reduced Ejection Fraction

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Abstract

Background. Compared with enalapril, sacubitril/valsartan reduces mortality from cardiovascular diseases and the number of hospitalizations for heart failure in patients with heart failure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling. The aim of the study is to determine the effect of sacubitril/valsartan on aortic stiffness and cardiac remodeling compared with enalapril in HFrEF. Materials and methods. In this long-term outpatient study, 100 patients with HFrEF received sacubitril/valsartan or enalapril. The primary endpoint was the change in arterial impedance (aortic stiffness characteristic) over a 12-month follow-up. Secondary endpoints included changes in N-terminal cerebral natriuretic propeptide (NT-proBNP), ejection fraction, left atrial volume index, E/e’ index, left ventricular end-systolic and end-diastolic volumes; left ventricular-arterial index (Ea/Ees). Results. During 12 months of follow-up, 100 patients showed significant differences between the groups with respect to changes in arterial impedance, which decreased from 224.0 to 207.9 dynes × s/ cm5 in the sacubitrile/valsartan group and increased from 213.5 to 214.1 dyne × s/cm5 in the enalapril group (difference between groups: –9.3 dynes × s/ cm5; 95% CI: from –16.9 to 12.8 dynes × s/cm5; p = 0.69). Also, there were intergroup differences in the change in left ventricular ejection fraction and Ea/Ees index. NT-proBNP level, left ventricular end-diastolic and systolic volume index, left atrial volume index, E/e’ index were reduced in the sacubitril/valsartan group. Conclusions. Treatment with sacubitril/valsartan compared with enalapril resulted in a significant reduction in aortic stiffness in HFrEF.

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About the authors

Alexey S. Ryazanov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: alexeydoc72@yandex.ru
ORCID iD: 0000-0003-2823-7774
SPIN-code: 5273-4570

MD, PhD, Professor

Russian Federation, 8-2, Trubetskaya street, Moscow, 119991

Evgenia V. Shikh

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: chih@mail.ru
ORCID iD: 0000-0001-6589-7654
SPIN-code: 2397-8414

MD, PhD, Professor

Russian Federation, 8-2, Trubetskaya street, Moscow, 119991

Konstantin I. Kapitonov

Clinical and Diagnostic Center No. 4

Email: kapitonov_k.i@rambler.ru
ORCID iD: 0000-0002-2750-0852
SPIN-code: 6331-4986

MD, PhD

Russian Federation, 3 Krylatskie holmy str., 121609, Moscow

Mariya V. Makarovskaya

Clinical and Diagnostic Center No. 4

Author for correspondence.
Email: marja.makarovska@mail.ru
ORCID iD: 0000-0002-2313-2159
SPIN-code: 4937-9454

MD

Russian Federation, 3 Krylatskie holmy str., 121609, Moscow

Alexey A. Kudryavtsev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: Firstfield@mail.ru
ORCID iD: 0000-0001-8294-5136
SPIN-code: 4403-2229

Аssistant

Russian Federation, 8-2, Trubetskaya street, Moscow, 119991

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