Effect of sacubitril valsartan on heart failure with mid-range or preserved ejection fraction in patients on maintenance hemodialysis: real-world experience in a single-center, prospective study

• Published in: BMC cardiovascular disorders 2024-01, Vol.24 (1), p.79-10, Article 79
• Main Authors: Huang, Xiao-Mei, Li, Jing-Jing, Yin, Wang, Fu, Hui-Ling, Yu, Fen, Gu, Lian-Qing, Zhang, Yi, Du, Min, Ye, Zheng, Xu, Li
• Format: Article
• Language: English
• Subjects: Aminobutyrates; Antihypertensives; Biphenyl Compounds; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - chemically induced; Care and treatment; Congestive heart failure; Diabetes mellitus; Drug dosages; Ejection fraction; Flow velocity; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart failure with mid-range ejection fraction; Heart failure with preserved ejection fraction; Hemodialysis; Hemodialysis patients; Hospitalization; Hospitals; Humans; Hyperkalemia; Hypertrophy; Hypotension; Kidney diseases; Mortality; Peritoneal dialysis; Prevention; Prospective Studies; Pulmonary arteries; Pulmonary hypertension; Renal Dialysis - adverse effects; Risk factors; Sacubitril valsartan; Software; Stroke Volume; Tetrazoles - adverse effects; Ultrasonic imaging; Valsartan - adverse effects; Velocity; Ventricle; Ventricular Function, Left
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-03744-y

This study aimed to evaluate the effect of sacubitril valsartan (SV) on heart failure (HF) hospitalization and cardiovascular mortality in patients on hemodialysis with HF with preserved ejection fraction (EF; HFpEF). This single-center, prospective study enrolled 155 stable hemodialysis patients with EF > 40% who were followed up for 12 months. Fifty-nine patients were treated with SV; the others were matched for EF (57.89 ± 9.35 vs. 58.00 ± 11.82, P = 0.9) at a ratio of 1:1 and included as controls. The target dosage of SV was 200 mg/day. Twenty-three (23/155; 14.84%) had HF with mid-range EF (HFmrEF), while 132 (85.16%) had HFpEF. After SV treatment, the peak early diastolic transmitral flow velocity/peak early diastolic mitral annular tissue velocity(E/e') improved from 17.19 ± 8.74 to 12.80 ± 5.52 (P = 0.006), the left ventricular (LV) end-diastolic diameter decreased from 53.14 ± 7.67 mm to 51.56 ± 7.44 mm (P = 0.03), and the LV mass index decreased from 165.7 ± 44.6 g/m to 154.8 ± 24.0 g/m (P = 0.02). LVEF (P = 0.08) and LV global longitudinal strain (P = 0.7) did not change significantly. The composite outcome of first and recurrent HF hospitalization or cardiovascular death showed no difference between group. However, the Acute Dialysis Quality Initiative Workgroup (ADQI) HF class improved in 39 and 15 patients and worsened in 1 and 11 patients in the SV and control groups, respectively (P  40%.