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The role of sacubitril/valsartan in the management of cardiac resynchronization therapy non-responders: a retrospective analysis

 Kyeong-Hyeon Chun  ;  Jaewon Oh  ;  Hee Tae Yu  ;  Chan Joo Lee  ;  Tae-Hoon Kim  ;  Jae Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung  ;  Seok-Min Kang 
 ESC HEART FAILURE, Vol.7(6) : 4404-4407, 2020-12 
Journal Title
Issue Date
Cardiac resynchronization therapy ; Heart failure with reduced ejection fraction ; Sacubitril/valsartan
Aims: Optimal medical therapy after cardiac resynchronization therapy (CRT) implantation is important in heart failure (HF) with reduced ejection fraction (HFrEF) patients. Although sacubitril/valsartan (SV) is a mainstay in the treatment of HFrEF, its efficacy in the management of CRT non-responders has not been emphasized. We aimed to investigate the efficacy of SV in CRT non-responders.

Methods and results: We analysed 175 HFrEF patients who received CRT implantation between January 2010 and January 2019. CRT responder was defined as a decrease in left ventricular (LV) end-systolic volume > 15% on echocardiography 6 months after implantation. Medical records were retrospectively reviewed. Patients underwent follow-up for HF rehospitalization, heart transplantation (HT), implantation of a LV assistant device (LVAD), cardiac death, and all-cause death. Among the study population, 164 patients were evaluated for CRT response; 54 (33%) were CRT non-responders. Four patients (6%) who received SV before CRT implantation were excluded, leaving 50 patients for analysis. Twenty-two non-responders (44%) received SV. There was no significant difference in baseline characteristics between SV users and non-users (n = 28). During follow-up, SV users had significantly lower incidence of all-cause death [1 (5%) vs. 10 (36%), P = 0.022] and tended to have lower HF rehospitalization [6 (27%) vs. 16 (57%), P = 0.068] and cardiac death (including HT and LVAD implant) [2 (9%) vs. 10 (36%), P = 0.064]. Kaplan-Meier survival analysis revealed that SV use was associated with a lower risk of cardiac death (including HT and LVAD implant) (log-rank P = 0.029).

Conclusions: SV treatment was related to a lower incidence of cardiac death including HT and LVAD implant in CRT non-responders. The optimization of HF management, including SV, should be considered in CRT non-responders.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
Chun, Kyeong Hyeon(전경현) ORCID logo https://orcid.org/0000-0002-7798-658X
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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