Effectiveness of sacubitril–valsartan in cancer patients with heart failure
Entity
UAM. Departamento de Medicina; Instituto de Investigación Sanitaria Hospital Universitario de La Paz (IdiPAZ)Publisher
John Wiley & Sons Ltd on behalf of the European Society of CardiologyDate
2020-02-05Citation
10.1002/ehf2.12627
ESC Heart Failure 7 ( 2020): 763–767
ISSN
2055-5822DOI
10.1002/ehf2.12627Funded by
This study was funded by the Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades, Spain, and the EU—European Regional Development Fund, by means of a competitive call for excellence in research projects (PIE14/00066) as well as by the Spanish Cardiovascular Network (CIBERCV).Project
Gobierno de España. PIE14/00066Editor's Version
http://doi.org/10.1002/ehf2.12627Subjects
Cancer; Cardio-oncology; Cardiotoxicity; Heart failure; Sacubitril–valsartan; MedicinaRights
© 2020 The AuthorsEsta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
Abstract
Aims Current guidelines recommend sacubitril/valsartan for patients with heart failure and reduced left ventricular ejection
fraction (LVEF), but there is lack of evidence of its efficacy and safety in cancer therapy-related cardiac dysfunction (CTRCD).
Our aim was to analyse the potential benefit of sacubitril/valsartan in patients with CTRCD.
Methods and results We performed a retrospective multicentre registry (HF-COH) in six Spanish hospitals with cardiooncology
clinics including all patients treated with sacubitril/valsartan. Demographic and clinical characteristics and laboratory
and echocardiographic data were collected. Median follow-up was 4.6 [1; 11] months. Sixty-seven patients were included (median
age was 63 ± 14 years; 64% were female, 87% had at least one cardiovascular risk factor). Median time from anti-cancer
therapy to CTRD was 41 [10; 141] months. Breast cancer (45%) and lymphoma (39%) were the most frequent neoplasm, 31%
had metastatic disease, and all patients were treated with combination antitumor therapy (70% with anthracyclines). Thirtynine
per cent of patients had received thoracic radiotherapy. Baseline median LVEF was 33 [27; 37], and 21% had atrial fibrillation.
Eighty-five per cent were on beta-blocker therapy and 76% on mineralocorticoid receptor antagonists; 90% of the
patients were symptomatic NYHA functional class ≥II. Maximal sacubitril/valsartan titration dose was achieved in 8% of patients
(50 mg b.i.d.: 60%; 100 mg b.i.d.: 32%). Sacubitril/valsartan was discontinued in four patients (6%). Baseline Nterminal
pro-B-type natriuretic peptide levels (1552 pg/mL [692; 3624] vs. 776 [339; 1458]), functional class (2.2 ± 0.6 vs.
1.6 ± 0.6), and LVEF (33% [27; 37] vs. 42 [35; 50]) improved at the end of follow-up (all P values ≤0.01). No significant statistical
differences were found in creatinine (0.9 mg/dL [0.7; 1.1] vs. 0.9 [0.7; 1.1]; P = 0.055) or potassium serum levels (4.5 mg/dL
[4.1; 4.8] vs. 4.5 [4.2; 4.8]; P = 0.5). Clinical, echocardiographic, and biochemical improvements were found regardless of the
achieved sacubitril–valsartan dose (low or medium/high doses).
Conclusions Our experience suggests that sacubitril/valsartan is well tolerated and improves echocardiographic functional
and structural parameters, N-terminal pro-B-type natriuretic peptide levels, and symptomatic status in patients with CTRCD.
Files in this item
Google Scholar:Martín-García, Ana
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López-Fernández, Teresa
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Mitroi, Cristina
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Chaparro-Muñoz, Marianela
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Moliner, Pedro
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Martín-García, Agustín C.
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Martínez-Monzonis, Amparo
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Castro, Antonio
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López-Sendón, José L.
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Sánchez, Pedro L.
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