Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices
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REVIEW ARTICLE
Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices Sijing Cheng1 · Nixiao Zhang1 · Wei Hua1 Accepted: 16 October 2020 © Springer Nature Switzerland AG 2020
Abstract For heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of reninangiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/ valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.
Key Points
1 Introduction
Sacubitril/valsartan is effective in patients with heart failure with reduced ejection fraction, and its utility is limited by hypotension.
Cardiovascular diseases (CVDs) are the leading cause of death, accounting for one-third of deaths [1]. Among these CVDs, heart failure (HF) is one of the major public health burdens. According to a report from the American Heart Association (AHA), an estimated 6.2 million American ≥ 20 years of age had HF based on data from 2013 to 2016, and it is estimated that the prevalence of HF will increase by 46% from 2012 to 2030, resulting in > 8 million adults with HF in the USA [2]. Despite considerable improvements in HF treatment, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin A T 1 receptor blockers (ARBs), β-blockers, and aldosterone antagonists, the outcome often remains unsatisfactory, defining an area of substantial unmet medical need. In addition to medication treatments, cardiac implantable electronic devices (CIEDs), especially implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT), are the most successful HF therapies. An ICD is a class I recommendation for patients with symptomatic HF and left ventricular ejection fraction (LVEF) ≤ 35% despite chronic guideline-directed medication therapy to reduce mortality. CRT improves cardiac performance in selected patients and reduces mortality and morbidity;
Sacubitril/valsartan has an effect on mortality, sudden cardiac death, and clinical and echocardiographic ou
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