PhD Scientific Days 2024

Budapest, 9-10 July 2024

Poster Session M - Cardiovascular Medicine and Research 1.

Sacubitril/Valsartan Has Superior Antiremodeling Effect Compared to Angiotensin-Converting Enzyme Inhibition in Myocardial Samples of Advanced Heart Failure Patients Undergoing Heart Transplantation


Dávid Nagy1, Tímea Bálint1, Petra Kocsis-Balogh1, Zoltán Horváth1, Attila Oláh1, Alex Ali Sayour1, Bálint András Barta1, Béla Merkely1, Tamás Radovits1, Mihály Ruppert1
1: Heart and Vascular Center, Semmelweis University

Text of the abstract

Background: The superiority of Sacubitril/Valsartan (SAC/VAL) treatment over angiotensin-converting enzyme inhibition (ACEi) in heart failure (HF) patients with reduced ejection fraction (HFrEF) could be attributed to a more robust direct cardioprotective effect. While this theory is supported by numerous experimental findings utilizing animal models of HF, human evidence remains restricted to echocardiography and circulating biomarkers.
Aims: We aimed to compare the anti-remodeling properties of SAC/VAL to ACEi on myocardial samples of HFrEF patients undergoing heart transplantation (HTX).
Method: Seventy advanced HF patients who underwent heart transplantation (HTX) and received either SAC/VAL (SAC/VAL group, N=32) or ACEi treatment (ACEi group, N=38) along with optimal HF medical therapy ( including a beta-blocker and mineralocorticoid receptor antagonist) for at least three months prior to HTX were enrolled in our analysis. The groups were matched for age, sex, ejection fraction and other basic clinical parameters. Left ventricular (LV) myocardial samples from the explanted heart of these patients were harvested during HTX. Myocardial B-type natriuretic peptide (BNP) expression was assessed by qRT-PCR. Interstitial fibrosis area was measured by histological analysis.
Results: The preoperative circulating N-terminal pro-BNP levels showed no difference between the study groups (SAC/VAL: 4363±752 pg/mL vs. ACEi: 4616±1020 pg/mL; p=0.911). However, LV myocardial BNP mRNA expression decreased in the SAC/VAL group (SAC/VAL: 2.3 ± 1.08 vs. ACEi: 5.3 ± 1.80; p=0.006) compared to the ACEi group. Furthermore, SAC/VAL treatment resulted in a lower interstitial myocardial fibrosis area, when compared to ACEi (SAC/VAL: 7.2±0.4% vs. ACEi: 8.6±0.5%; p=0.031).
Conclusion: SAC/VAL might exert a greater anti-remodeling effect on the myocardium of advanced HF patients undergoing HTX compared to ACEi treatment.
Funding: ÚNKP-23-3-I-SE-29 (D.N.), K134939 (T.R.), RRF-2.3.1-21-2022-00003, TKP2021-EGA-23