Background/Objectives: Heart transplantation (HTX) is the definitive treatment for
advanced heart failure (AdHF). The angiotensin receptor neprilysin inhibitor (ARNI)
sacubitril/valsartan (S/V) has been shown to reduce heart failure (HF) hospitalizations
and mortality when compared to conventionally administered HF medications (i.e. angiotensin-converting
enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs)). Nevertheless,
limited data are available on the hemodynamic (HD) effects of ARNI in patients with
AdHF. Therefore, the aim of the present study was to compare echocardiographic, laboratory,
and HD parameters relevant to HF before and after switching to ARNI in patients with
AdHF awaiting HTX. Methods: A retrospective analysis was conducted utilizing available
data on HD parameters, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels,
data on kidney function, HF therapy, and comorbidities. The study cohort comprised
13 AdHF patients (3 women, 10 men; mean age 56.4 ± 9 years) of whom 53.8% presented
with non-ischemic and 46.2% with ischemic etiology. All patients were awaiting heart
transplantation (HTX) and were transitioned to ARNI therapy between 2018 and 2021.
Results: After switching to ARNI, we observed significant improvements: in left ventricular
ejection fraction (LVEF: 27.27 ± 1.04% vs. 23.65 ± 1.02%, p = 0.03; data are given
as mean ± SEM after vs. before ARNI therapy, respectively), cardiac output (CO: 4.90
± 0.35 L/min vs. 3.83 ± 0.24 L/min, p = 0.013), and stroke volume (SV: 70.9 ± 5.9
mL vs. 55.5 ± 4.12 mL, p = 0.013). Significant reductions in systemic vascular resistance
(SVR: 1188 ± 79.8 vs. 1600 ± 100 DS/cm5, p = 0.004) and pulmonary vascular resistance
(PVR: 232.5 ± 34.8 vs. 278.9 ± 31.7 DS/cm5, p = 0.04) were also noted. Central venous
pressure (CVP), pulmonary arterial systolic and diastolic pressures (PAPs and PAPd),
pulmonary capillary wedge pressure (PCWP), and NT-proBNP levels did not exhibit significant
changes upon ARNI administration. Conclusions: Early transition to ARNI therapy offers
significant benefits for invasively measured hemodynamic parameters in patients with
AdHF, potentially aiding in the stabilization and improvement of this vulnerable patient
population.
