Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring.

Abstract

AIMS:

Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF).

METHODS AND RESULTS:

The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m2 ] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m2 , P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21).

CONCLUSIONS:

In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes.

• Authors: Michael Böhm, Birgit Assmus, Stefan D Anker, Folkert W Asselbergs, Johannes Brachmann, Marie-Elena Brett, Jasper J Brugts, Georg Ertl, AiJia Wang, Lutz Hilker, Friedrich Koehler, Stephan Rosenkranz, David M Leistner, Amr Abdin, Jan Wintrich, Qian Zhou, Philip B Adamson, Christiane E Angermann
• Journal: ESC heart failure (ESC Heart Fail) Vol. 9 Issue 1 Pg. 155-163 (02 2022) ISSN: 2055-5822 [Electronic] England
• PMID: 34738340 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Chemical References

• Aminobutyrates
• Angiotensin Receptor Antagonists
• Biphenyl Compounds
• Sodium Potassium Chloride Symporter Inhibitors
• Tetrazoles
• sacubitril
• Valsartan

Topics

• Aminobutyrates
• Angiotensin Receptor Antagonists (therapeutic use)
• Biphenyl Compounds
• Hemodynamic Monitoring
• Humans
• Pulmonary Artery
• Sodium Potassium Chloride Symporter Inhibitors
• Stroke Volume
• Tetrazoles (therapeutic use)
• Valsartan (therapeutic use)
• Ventricular Function, Left