Effects of sacubitril/valsartan on ventricular remodeling in patents with left ventricular systolic dysfunction following acute anterior wall myocardial infarction

Coron Artery Dis. 2021 Aug 1;32(5):418-426. doi: 10.1097/MCA.0000000000000932.

Abstract

Objective: The aim of this study was to investigate the effect of sacubitril/valsartan (Sal/Val) on left ventricular (LV) remodeling in patients with LV systolic dysfunction following acute anterior wall myocardial infarction (AAMI).

Methods: AAMI patients with LV systolic dysfunction were enrolled in this study. All patients underwent percutaneous coronary intervention. After hemodynamic stabilization, patients were randomly assigned either to group T (Sal/Val treatment) or group C (enalapril treatment). Changes in echocardiographic parameters and plasma biochemical markers were used to evaluate the effects of Sal/Val on LV remodeling and cardiac function. The incidence of major cardiac adverse events (MACEs) and adverse reactions during follow-ups was also recorded.

Results: In total, 137 eligible patients were prospectively included. Compared to group C, LV ejection fraction significantly improved (P < 0.05), while the LV end-systolic volume index and wall motion score index showed a tendency to decrease in group T. There was no difference in the LV end-diastolic volume index between groups. During follow-ups, the plasma N-terminal pro-B-type natriuretic peptide and soluble suppression of tumorigenesis-2 levels in both groups decreased (all P < 0.05), and the change was more prominent in group T. Additionally, drug-related adverse effects were similar between the two groups (P > 0.05); however, the incidence of MACEs was lower in group T than in group C (39.71% vs. 53.62%, P = 0.103), although the difference was insignificant.

Conclusion: Sac/Val attenuated LV remodeling and dysfunction and was safe and effective in LV systolic dysfunction patients post AAMI.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aminobutyrates* / administration & dosage
  • Aminobutyrates* / adverse effects
  • Angiotensin Receptor Antagonists / administration & dosage
  • Angiotensin Receptor Antagonists / adverse effects
  • Anterior Wall Myocardial Infarction* / complications
  • Anterior Wall Myocardial Infarction* / epidemiology
  • Anterior Wall Myocardial Infarction* / surgery
  • Biphenyl Compounds* / administration & dosage
  • Biphenyl Compounds* / adverse effects
  • Drug Combinations
  • Drug Monitoring / methods
  • Echocardiography / methods
  • Echocardiography / statistics & numerical data
  • Enalapril* / administration & dosage
  • Enalapril* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Percutaneous Coronary Intervention / methods
  • Stroke Volume
  • Treatment Outcome
  • Valsartan* / administration & dosage
  • Valsartan* / adverse effects
  • Ventricular Dysfunction, Left* / blood
  • Ventricular Dysfunction, Left* / drug therapy
  • Ventricular Dysfunction, Left* / etiology
  • Ventricular Dysfunction, Left* / physiopathology
  • Ventricular Remodeling / drug effects*

Substances

  • Aminobutyrates
  • Angiotensin Receptor Antagonists
  • Biphenyl Compounds
  • Drug Combinations
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Enalapril
  • Valsartan
  • sacubitril and valsartan sodium hydrate drug combination