The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test

Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide and is associated with severe impairment in functional capacity. In patients with chronic HF and reduced ejection fraction (HFrEF), the PARADIGM-HF (Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan reduced the risk of the composite of cardiovascular (CV) death or first hospitalization for heart failure (HF) by 20% compared to enalapril during a median follow-up of 27 months. Remarkably, the trial showed also an early beneficial effect of sacubitril/valsartan by reducing the risk of 30-day readmission for any cause and HF by 26% and 38%, respectively. However, there is limited data on the short-term effect of sacubitril/valsartan on patient's functional performance. Objective: To evaluate if there is any short term effect of Sacubitril/Valarstan drug on the functional capacity of stable HF patients with reduced ejection fraction, which is measured by the simple non-invasive six minute walk test, in only 30 days period. Methods: This is a prospectively studied a cohort of patients with chronic HF, visited outpatients clinics in Ain Shams University Hospital and 6 October University Hospital From November 1, 2018 to June 1, 2019. The inclusion criteria were: a) left ventricular systolic dysfunction ≤ 40%, b) stable New York Heart Association (NYHA) functional class ≥II, and c) prior treatment with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). In eligible patients, according to current guidelines, treatment with ACEI or ARB was replaced by sacubitril/valsartan. All patients provided informed consent and the protocol was approved by the research ethics committee in Ain Shams University. Results: Mean age of the studied patients was 55.07 ± 10.16 years, 83.3% males, 83.3% with ischemic cardiomyopathy, and 66.7% on NYHA functional class III. The mean (SD) of LVEF, 6-MWT, systolic blood pressure and estimated glomerular filtration rate were 30.00 ± 3.12 %, 279.33 ± 45.78 m, 114.33 ± 6.12 mm Hg and 64.83 ± 4.62 ml/min/1.73 m, respectively. The starting dos sacubitril/valsartan was 49/51 mg. Compared with baseline, the 6-MWT distance increased significantly at 30 days (+Δ = 92 m (40 – 150); p ≤ 0.001. In this observational study, treatment onset with sacubitril/valsartan was associated with 30-day improvement in the distance walked in 6-MWT. Further controlled studies are needed to confirm our results. Conclusion: In this observational study, treatment onset with sacubitril/valsartan was associated with 30-day improvement in the distance walked in 6-MWT. [Sameh Mohamed Mamoon Shaheen; Ehab Mohamed Abd Elkawi Elfekky; Sameh Mosaad Abdul-Wahab; Mohamed Ramzy Ragheb Mohamed. The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test. J Am Sci 2019;15(10):1-9. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience. org. 1. doi:10.7537/marsjas151019.01.