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Martínez-Falguera D, Aranyó J, Teis A, Ferrer-Curriu G, Monguió-Tortajada M, Fadeuilhe E, Rodríguez-Leor O, Díaz-Güemes I, Roura S, Villuendas R, Sarrias A, Bazan V, Delgado V, Bayes-Genis A, Bisbal F, Gálvez-Montón C. Antiarrhythmic and Anti-Inflammatory Effects of Sacubitril/Valsartan on Post-Myocardial Infarction Scar. Circ Arrhythm Electrophysiol 2024; 17:e012517. [PMID: 38666379 DOI: 10.1161/circep.123.012517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Sacubitril/valsartan (Sac/Val) is superior to angiotensin-converting enzyme inhibitors in reducing the risk of heart failure hospitalization and cardiovascular death, but its mechanistic data on myocardial scar after myocardial infarction (MI) are lacking. The objective of this work was to assess the effects of Sac/Val on inflammation, fibrosis, electrophysiological properties, and ventricular tachycardia inducibility in post-MI scar remodeling in swine. METHODS After MI, 22 pigs were randomized to receive β-blocker (BB; control, n=8) or BB+Sac/Val (Sac/Val, n=9). The systemic immune response was monitored. Cardiac magnetic resonance data were acquired at 2-day and 29-day post MI to assess ventricular remodeling. Programmed electrical stimulation and high-density mapping were performed at 30-day post MI to assess ventricular tachycardia inducibility. Myocardial samples were collected for histological analysis. RESULTS Compared with BB, BB+Sac/Val reduced acute circulating leukocytes (P=0.009) and interleukin-12 levels (P=0.024) at 2-day post MI, decreased C-C chemokine receptor type 2 expression in monocytes (P=0.047) at 15-day post MI, and reduced scar mass (P=0.046) and border zone mass (P=0.043). It also lowered the number and mass of border zone corridors (P=0.009 and P=0.026, respectively), scar collagen I content (P=0.049), and collagen I/III ratio (P=0.040). Sac/Val reduced ventricular tachycardia inducibility (P=0.034) and the number of deceleration zones (P=0.016). CONCLUSIONS After MI, compared with BB, BB+Sac/Val was associated with reduced acute systemic inflammatory markers, reduced total scar and border zone mass on late gadolinium-enhanced magnetic resonance imaging, and lower ventricular tachycardia inducibility.
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Affiliation(s)
- Daina Martínez-Falguera
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Faculty of Medicine, University of Barcelona, Spain (D.M.-F.)
| | - Júlia Aranyó
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- Department of Medicine, Autonomous University of Barcelona, Spain (J.A., A.B.-G.)
| | - Albert Teis
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Gemma Ferrer-Curriu
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
| | - Marta Monguió-Tortajada
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Department of Immunobiology, University of Lausanne, Epalinges, Vaud, Switzerland (M.M.-T.)
| | - Edgar Fadeuilhe
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Oriol Rodríguez-Leor
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Idoia Díaz-Güemes
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
| | - Santiago Roura
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
- Faculty of Medicine, University of Vic-Central University of Catalonia, Barcelona, Spain (S.R.)
| | - Roger Villuendas
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Axel Sarrias
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Victor Bazan
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Victoria Delgado
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- Department of Medicine, Autonomous University of Barcelona, Spain (J.A., A.B.-G.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Felipe Bisbal
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
| | - Carolina Gálvez-Montón
- ICREC Research Program, Germans Trias i Pujol Research Institute, Barcelona, Spain (D.M.-F., G.F.-C., M.M.-T., I.D.-G., S.R., A.B.-G., C.G.-M.)
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain (J.A., A.T., E.F., O.R.-L., S.R., R.V., A.S., V.B., V.D., A.B.-G., F.B., C.G.-M.)
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (O.R.-L., S.R., R.V., A.B-G., F.B., C.G.-M.)
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Acquaro M, Scelsi L, Pasotti B, Seganti A, Spolverini M, Greco A, Schirinzi S, Turco A, Sanzo A, Savastano S, Rordorf R, Ghio S. Sacubitril/valsartan effects on arrhythmias and left ventricular remodelling in heart failure: An observational study. Vascul Pharmacol 2023; 152:107196. [PMID: 37467909 DOI: 10.1016/j.vph.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
AIMS Conflicting results have been reported in the literature on the potential antiarrhythmic effect of sacubitril/valsartan in heart failure patients with reduced ejection fraction (HFrEF). The objectives of this study were: 1- to evaluate the long term effects of sacubitril/valsartan on arrhythmic burden in HFrEF patients; 2- to evaluate the correlation between the reduction of premature ventricular complexes during f-up and reverse remodelling. METHODS We identified 255 consecutive HFrEF patients treated with sacubitril/valsartan between March 2017 and May 2020 and followed by the Heart Failure and Cardiac Transplant Unit of IRCCS San Matteo Hospital in Pavia (Italy). Within this subgroup, 153 patients underwent 24 h-Holter-ECG or implantable cardioverter defibrillators (ICD) interrogation at baseline, at 12 months (t1) and at 24 months (t2) and transthoracic echocardiography at baseline and after 12 months after the beginning of sacubitril/valsartan. Cardiac-related hospitalizations were analyzed in the 12 months preceding and during 24 months following the drug starting date. RESULTS Global burden of 24-h premature ventricular complexes (PVC) was significantly reduced at 12 months (t1) and at 24 months (t2) as compared to the same period before treatment (1043 [304-3360] vs 768 [82-2784] at t1 vs 114 [9-333] at t2, P = 0.000). In the subgroup of patients implanted with biventricular ICD (n = 30), the percentage of biventricular pacing increased significantly (96% [94-99] vs 98% [96-99] at t1 vs 98%[97-100] at t2; P = 0.027). The burden of non-sustained ventricular tachycardia and sustained ventricular tachycardia did not change from baseline to t1 and t2, but a reduction of patients with at least one ICD appropriate shock was reported. The correlations between reduction in 24 h PVC and reduction in LV-ESVi or improvement in LVEF were not statistically significant (respectively R = 0.144, P = 0.197 and R = -0.190, P = 0.074). Heart failure related hospitalizations decreased during follow up (11.1% in the year before treatment vs 4.6% at t1 and 4.6% at t2; P = 0.040). CONCLUSION Sacubitril/valsartan reduced the number of premature ventricular complexes and increased the percentage of biventricular pacing in a cohort of HFrEF patients already on optimal medical therapy. PVC reduction did not correlate with reverse left ventricular remodelling. Whether sacubitril/valsartan has any direct antiarrhythmic effects is an issue to be better explored in future studies.
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Affiliation(s)
- Mauro Acquaro
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Pasotti
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Seganti
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marcello Spolverini
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sandra Schirinzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sanzo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Roberto Rordorf
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Liu XH, Wang GL, Xu Q, Zhang L, Liu HJ. Effect of sacubitril/valsartan on the occurrence of cardiac arrhythmias and the risk of sudden cardiac death in heart failure: A meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:943377. [PMID: 36148074 PMCID: PMC9489142 DOI: 10.3389/fcvm.2022.943377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sacubitril/valsartan therapy reduced the risks of death and of hospitalization for heart failure (HF). HF and cardiac arrhythmias have shared physiological mechanisems. Therefore, sacubitril/valsartan may exhibit anti-arrhythmic properties in HF. The purpose of this study was to evaluate the effect of sacubitril/valsartan on the occurrence of cardiac arrhythmias and the risk of sudden cardiac death (SCD) in HF. Methods This meta-analysis was performed according to PRISMA guidelines. We searched PubMed and Embase (from inception up to 6 February 2022) to identify randomized control trials (RCTs) on the effect of sacubitril/valsartan on the occurrence of cardiac arrhythmias and the risk of SCD in HF. Primary outcomes were the occurrence of atrial arrhythmias, ventricular arrhythmias, and SCD. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model for meta-analysis. Results We included 9 RCTs (published between 2012 and 2021) with 18,500 patients (9,244 sacubitril/valsartan vs. 9,256 active control). Enalapril and valsartan were used as active control in six and two studies, respectively. Follow-up ranged from 2 to 35 months. The cumulative occurrence of events was 76, 13, and 48 per 1,000 patient-years for atrial arrhythmias, ventricular arrhythmias and SCD, respectively. There was no significant association between sacubitril/valsartan therapy and the occurrence of atrial arrhythmias (RR 1.06; 95% CI: 0.97–1.17; P = 0.19) and ventricular arrhythmias (RR 0.86; 95% CI 0.68–1.10; P = 0.24). However, sacubitril/valsartan therapy significantly reduced the risk of SCD (RR 0.79; 95% CI 0.70–0.90; P = 0.03) compared with control. Conclusion No association between sacubitril/valsartan therapy and the occurrence of atrial and ventricular arrhythmias was found, but sacubitril/valsartan therapy significantly reduced the risk of SCD.
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Affiliation(s)
- Xue-Hui Liu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | | | - Qiang Xu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | - Lei Zhang
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
| | - Hong-Jun Liu
- Department of Cardiology, Yichang Hospital of Traditional Chinese Medicine, Yichang, China
- Traditional Chinese Medicine Hospital of China Three Gorges University, China Three Gorges University, Yichang, China
- *Correspondence: Hong-Jun Liu,
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Primessnig U, Deißler PM, Wakula P, Tran KL, Hohendanner F, von Lewinski D, Blaschke F, Knosalla C, Falk V, Pieske B, Grubitzsch H, Heinzel FR. Effects of BNP and Sacubitrilat/Valsartan on Atrial Functional Reserve and Arrhythmogenesis in Human Myocardium. Front Cardiovasc Med 2022; 9:859014. [PMID: 35865376 PMCID: PMC9294287 DOI: 10.3389/fcvm.2022.859014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan started a new era in heart failure (HF) treatment, less is known about the tissue-level effects of the drug on the atrial myocardial functional reserve and arrhythmogenesis.Methods and ResultsRight atrial (RA) biopsies were retrieved from patients (n = 42) undergoing open-heart surgery, and functional experiments were conducted in muscle strips (n = 101). B-type natriuretic peptide (BNP) did not modulate systolic developed force in human myocardium during β-adrenergic stimulation, but it significantly reduced diastolic tension (p < 0.01) and the probability of arrhythmias (p < 0.01). In addition, patient's plasma NTproBNP positively correlated with isoproterenol-induced contractile reserve in atrial tissue in vitro (r = 0.65; p < 0.01). Sacubitrilat+valsartan (Sac/Val) did not show positive inotropic effects on atrial trabeculae function but reduced arrhythmogeneity. Atrial and ventricular biopsies from patients with end-stage HF (n = 10) confirmed that neprilysin (NEP) is equally expressed in human atrial and ventricular myocardium. RA NEP expression correlates positively with RA ejection fraction (EF) (r = 0.806; p < 0.05) and left ventricle (LV) NEP correlates inversely with left atrial (LA) volume (r = −0.691; p < 0.05).ConclusionBNP ameliorates diastolic tension during adrenergic stress in human atrial myocardium and may have positive long-term effects on the inotropic reserve. BNP and Sac/Val reduce atrial arrhythmogeneity during adrenergic stress in vitro. Myocardial NEP expression is downregulated with declining myocardial function, suggesting a compensatory mechanism in HF.
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Affiliation(s)
- Uwe Primessnig
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Peter M Deißler
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Paulina Wakula
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Khai Liem Tran
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Felix Hohendanner
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Christoph Knosalla
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Volkmar Falk
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Herko Grubitzsch
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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