Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study

Author(s):Show less -

dos Santos, Marcelo Rodrigues ^[1] ; Nunes Alves, Maria-Janieire de Nazare ^[1] ; Jordao, Camila Paixao ^[1] ; Novaes Pinto, Caio Eduardo ^[1] ; Souza Correa, Kelly Thayane ^[1] ; de Souza, Francis Ribeiro ^[1] ; Peixoto da Fonseca, Guilherme Wesley ^[1] ; Tomaz Filho, Joaquim ^[1] ; Costa, Marcel ^[1] ; Rodrigues Pereira, Rosa Maria ^[2] ; Negrao, Carlos Eduardo ^{[1, 3]} ; Pereira Barretto, Antonio Carlos ^[1]

Affiliation

^[1] Univ Sao Paulo, Inst Coracao InCor, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Lab Metab Osseo, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Escola Educ Fis & Esporte, Sao Paulo - Brazil

• Document type: Journal article
• Source: AMERICAN HEART JOURNAL; v. 239, p. 1-10, SEP 2021.
• Web of Science Citations: 0

Abstract

Background Sacubitril/valsar tan reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) when compared with enalapril. However, it is unknown the effect of both treatments on exercise capacity. We compared sacubitril/valsartan versus enalapril in patients with HFrEF based on peak oxygen consumption (VO2) and 6-minute walk test (6-MWT). Methods We included 52 participants with HFrEF with a left ventricular ejection fraction <40% to receive either sacu-bitril/ valsartan (target dose of 400 mg daily) or enalapril (target dose of 40 mg daily). Peak VO2 was measured by using cardiopulmonary exercise testing. Six-minute walk test was also performed. Results At 12 weeks, the sacubitril/valsartan (mean dose 382.6 +/- 57.6 mg daily) group had increased peak VO2 of 13.1% (19.35 +/- 0.99 to 21.89 +/- 1.04 mL/kg/min) and enalapril (mean dose 34.4 +/- 9.2 mg daily) 5.6% (18.58 +/- 1.19 to 19.62 +/- 1.25 mL/kg/min). However, no difference was found between groups (P = .332 interaction). At 24 weeks, peak VO2 increased 13.5% (19.35 +/- 0.99 to 21.96 +/- 0.98 mL/kg/min) and 12.0% (18.58 +/- 1.19 to 20.82 +/- 1.18 mL/kg/min) in sacubitril/valsartan (mean dose 400 +/- 0 mg daily) and enalapril (mean dose 32.7 +/- 11.0 mg daily), respectively. However, no differences were found between groups (P = .332 interaction). At 12 weeks, 6-MWT increased in both groups (sacubitril/valsartan: 459 +/- 18 to 488 +/- 17 meters {[}6.3%] and enalapril: 443 +/- 22 to 477 +/- 21 meters {[}7.7%]). At 24 weeks, sacubitril/valsartan increased 18.3% from baseline (543 +/- 26 meters) and enalapril decreased slightly to 6.8% (473 +/- 31 meters), but no differences existed between groups (P = .257 interaction). Conclusions Compared to enalapril, sacubitril/valsartan did not substantially improve peak VO2 or 6-MWT after 12 or 24 weeks in participants with HFrEF. (AU)

• FAPESP's process: 16/24833-0 - The effect of neprilysin (LCZ696) on exercise tolerance, muscle vasodilatation, muscle strength and body composition in patients with heart failure - NEPRIExTol-HF trial
• Grantee: Antonio Carlos Pereira-Barretto
• Support Opportunities: Regular Research Grants
• FAPESP's process: 16/24306-0 - The effect of NEPRIlysin (LCZ696) on EXercise TOLerance, muscle vasodilatation, muscle strength and body composition in patients with Heart Failure - NEPRIExTol-HF Trial
• Grantee: Marcelo Rodrigues dos Santos
• Support Opportunities: Scholarships in Brazil - Post-Doctorate
• FAPESP's process: 19/14938-7 - A 28-day study to evaluate the physiologic effects of beta-nicotinamide mononucleotide on hepatic fat, insulin sensitivity, muscle bioenergetics and performance, and other NAD+-dependent physiologic processes in middle-aged and older men and women
• Grantee: Marcelo Rodrigues dos Santos
• Support Opportunities: Scholarships abroad - Research Internship - Post-doctor