Journal Article

Sacubitril/valsartan on right ventricular-pulmonary artery coupling and albumin-bilirubin score in heart failure in Chinese patients with reduced ejection fraction

Shi, Yanan, Xu, Yu, Gao, Chuanyu, Yuan, Fang

2025

Overview

Objective Impaired right ventricular (RV)-pulmonary arterial (PA) coupling, calculated by measuring the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), can be used as an early indicator of right ventricular dysfunction (RVD) in patients with heart failure with a reduced ejection fraction (HFrEF). Patients suffering from HFrEF experience improvements in left ventricular (LV) function through the administration of sacubitril/valsartan therapy. In addition, the albumin-bilirubin (ALBI) score was associated with the fluid overload status and adverse clinical outcomes in patients with heart failure. This study aimed to assess whether angiotensin receptor-neprilysin inhibitor (ARNI) affects the TAPSE /PASP in patients with HFrEF, and whether there is a correlation between changes in the ALBI score and ARNI treatment. Methods A retrospective observational study was conducted on 305 patients with HFrEF and RVD who were hospitalized between June 2020 and December 2021. One year after treatment, laboratory test results, ALBI score, transthoracic echocardiography (TTE), New York Heart Association classification, Minnesota Living with Heart Failure Questionnaire scores and changes in relevant variables were reevaluated. Results Compared to before sacubitril/valsartan treatment, the ALBI was found to be significantly reduced after one year of follow-up (-2.42 ± 0.37 vs. -2.51 ± 0.32, p  < 0.001). Additionally, A significant improvement was demonstrated in the following echocardiography parameters assessing RV function after 1 year of treatment with sacubitril/valsartan: TAPSE (15 ± 1 vs. 18 ± 2 mm, p  < 0.001), PASP (45 ± 8 vs. 40 ± 9 mmHg, p  < 0.001), pulmonary artery diastolic pressure (PADP) (22 ± 4 vs. 19 ± 4 mmHg, p  < 0.001), RV-PA coupling (0.35 ± 0.08 vs. 0.48 ± 0.12, p  < 0.001), and RV s’(8.7 ± 2.2 vs. 9.5 ± 2.6 cm/s, p  < 0.001). Multivariate analysis showed that the improvement of RV-PA coupling was associated with baseline PASP ( r: -0.45, p  < 0.001) and PADP ( r: -0.45, p  < 0.001). Conclusions Sacubitril/valsartan improves RV-PA conjugation in patients with RVD and HFrEF, and has a positive impact on the ALBI score by improving liver function in patients with HFrEF.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Albumin / Albumin-bilirubin (ALBI) score / Albumins / Aminobutyrates - therapeutic use / Angiotensin / Angiotensin Receptor Antagonists - therapeutic use / Bilirubin / Bilirubin - blood / Biphenyl Compounds - therapeutic use / Blood pressure / Cardiac Surgery / Cardiovascular disease / China / Chronic obstructive pulmonary disease / Clinical outcomes / Congestive heart failure / Conjugation / Coupling / Diabetes / Diastolic pressure / Drug Combinations / Echocardiography / Ejection fraction / Failure / Female / Flow velocity / Heart / Heart failure / Heart Failure - blood / Heart Failure - drug therapy / Heart Failure - physiopathology / Heart failure with reduced ejection fraction / Heart Ventricles - diagnostic imaging / Heart Ventricles - physiopathology / Humans / Hypertension / Ivabradine / Liver / Male / Medical prognosis / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Multivariate analysis / Neprilysin / Patients / Pulmonary arteries / Pulmonary artery / Pulmonary Artery - drug effects / Pulmonary Artery - physiopathology / Retrospective Studies / Right ventricular pulmonary coupling / RV-PA coupling / Sacubitril/valsartan / Stroke Volume - physiology / Systolic pressure / Thoracic Surgery / Valsartan / Valsartan - therapeutic use / Variables / Ventricle / Ventricular Dysfunction, Right - drug therapy / Ventricular Dysfunction, Right - physiopathology