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EFFECTS OF SACUBITRIL/VALSARTAN ON THE ARTERIAL STIFFNESS AND LEFT VENTRICULAR-ARTERIAL COUPLING IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

https://doi.org/10.20996/1819-6446-2018-14-2-210-216

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Abstract

Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC) and arterial stiffness in HFrEF patients.

Material and methods. Arterial stiffness by applanation tonometry and LVAC – by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69Ѓ}9 years, 89% male, arterial hypertension – 83%, diabetes – 39%, myocardial infarction – 89%, left ventricular ejection fraction 32Ѓ}4%) initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance)/ Ees (left ventricular elastance) ratio. Differences were considered statistically significant at p<0.05.

Results. 72% of patients initially had elevated pulse wave velocity (PWV>10 m/s). The decrease in PWV (from 11.5Ѓ}2.9 to 10.2Ѓ}2.9 m/s, p<0.05), of the augmentation pressure (from 15.3Ѓ}8.9 to 10.5Ѓ}5.0 mm Hg, p=0.002), the increase in the reflected wave transit time (from 132Ѓ}9 to 143Ѓ}29 ms, p=0.02) and the subendocardial viability ratio (from 164Ѓ}25 to 177Ѓ}37%; p=0.009) were found after 12 months. Sacubitryl/valsartanbased therapy was associated with a decrease in central systolic blood pressure (from 116Ѓ}19 to 106Ѓ}10 mm Hg; p=0.001) and central pulse blood pressure (from 44Ѓ}15 to 38Ѓ}7 mm Hg; p<0.05). Decrease in Ea (from 2.20Ѓ}0.84 to 1.79Ѓ}0.63 mm Hg/ml/m2; p=0.005) and Ea/Ees ratio (from 2.26Ѓ}0.77 to 1.68Ѓ}0.32, p=0.05) was found after 12 months. Ees did not change statistically significantly (1.00Ѓ}0.34 vs 1.01Ѓ}0.44 mm Hg/ml/m2). The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found.

Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave.

About the Authors

Zh. D. Kobalava
Peoples' Friendship University of Russia (RUDN University)
Russian Federation

Zhanna D. Kobalava – MD, PhD, Professor, Head of Chair of Internal Medicine with Course of Cardiology and Functional Diagnostics, Head of Chair of Internal Medicine, Cardiology and Functional Diagnostics of the Faculty of Advanced Training of Medical Workers, Medical Institute

Miklukho-Maklaya ul. 6, Moscow, 117198

 



S. V. Villevalde
Peoples' Friendship University of Russia (RUDN University)
Russian Federation

Svetlana V. Villevalde – MD, PhD, Professor, Chair of Internal Medicine with Course of Cardiology and Functional Diagnostics, Medical Institute

Miklukho-Maklaya ul. 6, Moscow, 117198



I. A. Meray
Peoples' Friendship University of Russia (RUDN University)
Russian Federation

Imad A. Meray – MD, PhD, Associate Professor, Chair of Internal Medicine with Course of Cardiology and Functional Diagnostics, Medical Institute

Miklukho-Maklaya ul. 6, Moscow, 117198



Е. E. Shkolnikova
Peoples' Friendship University of Russia (RUDN University)
Russian Federation

Ekaterina E. Shkolnikova – MD, PhD, Associate Professor, Chair of Internal Medicine with Course of Cardiology and Functional Diagnostics, Medical Institute

Miklukho-Maklaya ul. 6, Moscow, 117198



O. I. Lukina
Peoples' Friendship University of Russia (RUDN University)
Russian Federation

Olga I. Lukina – MD, Postgraduate Student, Chair of Internal Medicine with Course of Cardiology and Functional Diagnostics, Medical Institute

Miklukho-Maklaya ul. 6, Moscow, 117198



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For citation:


Kobalava Z.D., Villevalde S.V., Meray I.A., Shkolnikova Е.E., Lukina O.I. EFFECTS OF SACUBITRIL/VALSARTAN ON THE ARTERIAL STIFFNESS AND LEFT VENTRICULAR-ARTERIAL COUPLING IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION. Rational Pharmacotherapy in Cardiology. 2018;14(2):210-216. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-2-210-216

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