Early Effects of Sacubitril/Valsartan on Exercise Tolerance in Patients with Heart Failure with Reduced Ejection Fraction

Background. Sacubitril/valsartan in heart failure (HF) with reduced ejection fraction (HFrEF) was shown to be superior to enalapril in reducing the risk of death and hospitalization for HF. Our aim was to evaluate the cardiopulmonary effects of sacubitril/valsartan in patients with HFrEF. Methods. We conducted an observational study. Ninety-nine ambulatory patients with HFrEF underwent serial cardiopulmonary exercise tests (CPET) after initiation of sacubitril/valsartan in addition to recommended therapy. Results. At baseline, 37% of patients had New York Heart Association (NYHA) class III. After a median follow-up of 6.2 months (range 3-14.9 months) systolic blood pressure decreased from 117 +/- 14 to 101 +/- 12 mmHg (p < 0.0001), left ventricular ejection fraction (LVEF) increased from 27 +/- 6 to 29.7 +/- 7% (p < 0.0001), peak oxygen consumption (VO2) improved from 14.6 +/- 3.3 (% of predicted = 53.8 +/- 14.1) to 17.2 +/- 4.7 mL/kg/min (% of predicted = 64.7 +/- 17.8) (p < 0.0001), minute ventilation/carbon dioxide production relationship (VE/VCO2 Slope) decreased from 34.1 +/- 6.3 to 31.7 +/- 6.1 (p = 0.006), VO2 at anaerobic threshold increased from 11.3 +/- 2.6 to 12.6 +/- 3.5 mL/kg/min (p = 0.007), oxygen pulse increased from 11.5 +/- 3.0 to 13.4 +/- 4.3 mL/kg/min (p < 0.0001), and Delta VO2/Delta Work increased from 9.2 +/- 1.5 to 10.1 +/- 1.8 mL/min/watt (p = 0.0002). Conclusion. Sacubitril/valsartan improved exercise tolerance, LVEF, peak VO2, and ventilatory efficiency at 6.2 months follow-up. Further studies are necessary to better clarify underlying mechanisms of this functional improvement.