Switching from ramipril to sacubitril/valsartan favorably alters electrocardiographic indices of ventricular repolarization in heart failure with reduced ejection fraction


Okutucu S., Sabanoglu C., Sayin B. Y., Aksoy H., BURSA N., Oto A.

ACTA CARDIOLOGICA, cilt.75, sa.1, ss.20-25, 2020 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 75 Sayı: 1
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1080/00015385.2018.1535818
  • Dergi Adı: ACTA CARDIOLOGICA
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.20-25
  • Hacettepe Üniversitesi Adresli: Evet

Özet

Background: Angiotensin receptor neprilysin inhibitor (ARNI, sacubitril/valsartan) reduces sudden death in heart failure with reduced ejection fraction (HFrEF). Corrected QT (QTc), T-wave peak to T-wave end interval (Tp-e) and Tp-e/QTc are electrocardiographic indices of ventricular repolarization heterogeneity. We aimed to assess the effects of switching from ramipril to ARNI on electrocardiographic indices of ventricular repolarization. Methods: A total of 48 patients with HFrEF (mean age: 63.3 +/- 11.7 years; 36 males, 77.1% ischaemic etiology) were enrolled. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction <= 35% and previously switched from ramipril to ARNI treatment. The standard 12-lead electrocardiograms on ramipril treatment and 1 month after ARNI treatment were analysed; heart rate, QTc, Tp-e and Tp-e/QTc were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N-terminal pro-BNP (NT-proBNP) values were recorded. Results: QTc (415.2 +/- 19.7 ms vs. 408.5 +/- 20.8 ms, p = 0.022), Tp-e (100.7 +/- 13.8 ms vs. 92.9 +/- 12.1 ms, p < 0.001), Tp-e/QTc (0.242 +/- 0.028 vs. 0.227 +/- 0.029, p = 0.003) and heart rate (73.2 +/- 4.7 bpm vs. 71.1 +/- 4.9 bpm, p = 0.027) were reduced after ARNI. ARNI switch associated with improvement in MLWHFQ scores (32.4 +/- 7.1 ms vs. 22.6 +/- 7.0 ms, p < 0.001) and reduction of NT-proBNP (2457 +/- 1879 pg/ml to 1377 +/- 874 pg/ml, p < 0.001). Pearson's correlation analysis revealed moderate correlations of MLWHFQ score with Tp-e (r = 0.543, p = 0.001) and Tp-e/QTc (r = 0.556, p = 0.001). Conclusions: Switching from ramipril to ARNI favourably alters QTc, Tp-e and Tp-e/QTc in HFREF. ARNI reduces symptoms of HFREF assessed by MLWHFQ and lowers NT-proBNP levels. Reduction in Tp-e and Tp-e/QTc correlate with clinical improvement in patients with HFrEF.