The following is the summary of “Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study” published in the December 2022 issue of Heart failure by Fusco, et al.
Patients with heart failure and a low ejection fraction on sacubitril/valsartan had a lower hospitalization rate and a lower mortality rate. Sacubitril/valsartan has yet to have its efficacy in patients with a systemic right ventricle evaluated. Patients with congenitally repaired transposition of the great arteries or those who underwent the Senning-Mustard operation for transposition of the great arteries were prospectively included if they had compromised systemic right ventricle systolic function.
Sacubitril/effectiveness valsartan and safety were the primary measures of success. NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic function improvement were the primary efficacy end goals. Quality of life improvement, 6-minute walk distance, and New York Heart Association class were considered secondary end goals. About 50 patients were included and followed for a year (mean age 38±12 years; 60% male; 35% congenitally repaired transposition of the great arteries). There were no serious side effects. 1 patient (2%), had a nephrotic syndrome, while 2 patients (4%) discontinued treatment due to hypotension. 20 patients (42%) received their prescribed dose. In the first few days after starting treatment, NT-proBNP levels dropped considerably, and they were back to normal after a year. Echocardiography revealed an increasing fractional area change (29.2±5.8% versus 34.9±5.1%; P<0.001), right ventricular global longitudinal strain (-13.9 [-15.1, -11.8] versus -15.3 [-17.2, -13.4]%; P<0.001), and free-wall global longitudinal strain (-14.3 [-17.3, -12.3] versus -17.2 [-19.3, -15.8]%; 3 -dimensional echocardiography also showed a rise in systemic right ventricular ejection fraction (35.6±8.1 against 41.5±7.5%; P<0.001) and a decrease in right ventricle sizes (end-diastolic volume: 181±63 versus 156±50 mL; P=0.002; end-systolic volume: 117±48 versus 89±33 mL; P<0.001).
Change in New York Heart Association class (P<0.001), higher 6-minute walking distance (425 [333, 480] versus 500 [443, 560] m; P<0.001), and improved quality of life at 1-year follow-up all imply clinical improvement. The beneficial benefits were more pronounced in individuals on target dose but were seen regardless of the underlying architecture. Their results suggest that sacubitril/valsartan can be safely used in this difficult patient population, as it improves systolic function and clinical status while also being well tolerated.