Heart failure & cardiomyopathies
Vascular Endothelial Effects of Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction: Randomized Controlled Trial
Authors' conclusion
In this randomized double-blind clinical trial addressing mechanisms, sacubitril/valsartan lowered blood pressure and flicker-induced dilatation of retinal venules in patients with symptomatic HFrEF but did not improve endothelial function, retinal microvascular function, or arterial stiffness compared to valsartan monotherapy.
Study context
- Population
- Stable heart failure with reduced ejection fraction (HFrEF) patients, NYHA class II–IV, on guideline-recommended therapy (mean age 59.4 ± 12 years, LVEF 30% ± 7%)
- Participants
- 79 patients
- Comparison
- Sacubitril/valsartan vs valsartan alone
- Primary endpoint
- Flow-mediated vasodilation (FMD)
- Follow-up
- 3 months
Methodological detailsdouble-blind
- Double-blind
Primary result
FMD
ANCOVA coefficient
0.36
95% CI −0.78 to 1.51
P = 0.53
By group
As reported in the abstract
Secondary outcomes
| Outcome | Sacubitril/valsartan | Valsartan | Estimate | P value |
|---|---|---|---|---|
| Flicker-induced dilatation of retinal venules (FIDv) | 2.4% (SD 1.3%) | 3.1% (SD 2.1%) | ANCOVA coefficient −0.7 (95% CI −1.4 to −0.02) | P = 0.04 |
| SBP | ANCOVA coefficient −6.5 mm Hg (95% CI −12.7 to −0.3) | P = 0.04 |
Flicker-induced dilatation of retinal arterioles, arteriovenous ratio, pulse wave velocity, augmentation index
- No significant differences
Safety
Serious adverse events
- Numerically fewer with sacubitril/valsartan vs valsartan alone
Original publication
Vascular Endothelial Effects of Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction: Randomized Controlled Trial. JACC Adv. Published 13 November 2024. doi:10.
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