Sympathoinhibitory effect of sacubitril-valsartan in heart failure with reduced ejection fraction: A pilot study

Kanokwan Bunsawat; Stephen M. Ratchford; Jeremy K. Alpenglow; Josef Stehlik; Adam S. Smith; Russell S. Richardson; D. Walter Wray

doi:10.1016/j.autneu.2021.102834

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$Sympathoinhibitory effect of sacubitril-valsartan in heart failure with reduced ejection fraction: A pilot study$

Journal article

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Sympathoinhibitory effect of sacubitril-valsartan in heart failure with reduced ejection fraction: A pilot study

Kanokwan Bunsawat, Stephen M. Ratchford, Jeremy K. Alpenglow, Josef Stehlik, Adam S. Smith, Russell S. Richardson and D. Walter Wray

Autonomic neuroscience, Vol.235, pp.102834-102834

11/01/2021

DOI: 10.1016/j.autneu.2021.102834

PMCID: PMC8455423

PMID: 34186274

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https://www.ncbi.nlm.nih.gov/pmc/articles/8455423View

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Abstract

Chronic sympathetic nervous system (SNS) overactivity, characteristic of heart failure (HF) with reduced ejection fraction (HFrEF), is associated with poor prognosis and contributes to increased mortality risk. Sacubitrilvalsartan is a recently approved, first-in-class, angiotensin receptor neprilysin inhibitor (ARNI) drug that markedly reduces the risks of death from cardiovascular causes and hospitalization for HF in patients with HFrEF, but the physiological mechanisms underlying these benefits are not fully understood. This single-arm, open-label, prospective study sought to test the hypothesis that short-term treatment with sacubitril-valsartan reduces SNS activity, measured directly via muscle sympathetic nerve activity (MSNA), in patients with HFrEF. MSNA, heart rate (HR), and arterial blood pressure (BP) were assessed in stable Class II and III patients with HFrEF (n = 9, 69 +/- 8 yrs.; 28.6 +/- 3.6 kg/m(2)) on contemporary, guideline-directed medical treatment who were subsequently started on sacubitril-valsartan. These measurements were repeated after two months of treatment with sacubitril-valsartan. Sacubitril-valsartan reduced MSNA burst frequency (baseline: 43 +/- 10 bursts/min; 2-month: 36 +/- 10 bursts/min, p = 0.05) and burst incidence (baseline: 68 +/- 16 bursts/100 heartbeats; 2-month: 55 +/- 16 bursts/100 heartbeats, p = 0.02), while HR and BP were unchanged following the treatment (p > 0.05). These preliminary findings provide new evidence regarding the ability of sacubitrilvalsartan to rapidly reduce SNS activity in patients with HFrEF, suggesting the presence of a novel sympathoinhibitory effect of this new drug class.

Life Sciences & Biomedicine

Neurosciences

Neurosciences & Neurology

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Details

Title: Subtitle: Sympathoinhibitory effect of sacubitril-valsartan in heart failure with reduced ejection fraction: A pilot study
Creators: Kanokwan Bunsawat - University of Utah
Stephen M. Ratchford - George E. Wahlen Department of VA Medical Center
Jeremy K. Alpenglow - University of Utah
Josef Stehlik - University of Utah
Adam S. Smith - University of Utah
Russell S. Richardson - University of Utah
D. Walter Wray - University of Utah
Resource Type: Journal article
Publication Details: Autonomic neuroscience, Vol.235, pp.102834-102834
DOI: 10.1016/j.autneu.2021.102834
PMID: 34186274
PMCID: PMC8455423
NLM abbreviation: Auton Neurosci
ISSN: 1566-0702
eISSN: 1872-7484
Publisher: Elsevier
Number of pages: 7
Grant note: 18POST33960192 / American Heart Association R01 HL118313; R56 AG057584; T32 HL139451 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA RX001311; E6910-R; E1697-R; E3207-R; E1572-P; E9275-L / U.S. Department of Veterans Affairs; US Department of Veterans Affairs
Language: English
Date published: 11/01/2021
Academic Unit: Health, Sport, and Human Physiology
Record Identifier: 9984948141602771

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