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03.12.2019 | Original articles

Effects of angiotensin receptor neprilysin inhibition on P-wave dispersion in heart failure with reduced ejection fraction

verfasst von: Assoc. Prof. Sercan Okutucu, MD, FESC, FACC, FAHA, FAPSC, Sefik Gorkem Fatihoglu, MD, Cengiz Sabanoglu, MD, Nurbanu Bursa, Begum Yetis Sayin, MD, Associate Professor Hakan Aksoy, MD, Professor Ali Oto, MD, FESC, FACC, FHRS, FISHNE

Erschienen in: Herz | Sonderheft 1/2021

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Abstract

Background

Angiotensin receptor neprilysin inhibitors (ARNI; sacubitril/valsartan combination) decrease morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). Increased P‑wave duration and P‑wave dispersion (P_d) reflect prolongation of atrial conduction and correlate with atrial fibrillation. Here, we aimed to assess the effects of switching from valsartan to ARNI treatment on the basis of P‑wave indices.

Methods

A total of 28 patients with HFrEF (mean age, 64.8 ± 10.6 years; 18 males, 78.6% ischemic etiology) were included. All patients had New York Heart Association functional class II–III, left ventricular ejection fraction ≤35%, and had been switched from valsartan to ARNI treatment. Standard 12-lead electrocardiograms from patients on valsartan treatment and electrocardiograms 1 month after ARNI treatment were analyzed; heart rate, maximum P‑wave duration (P_max), minimum P‑wave duration (P_min), and P_d were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N‑terminal pro-brain natriuretic peptide (NT-proBNP) values were recorded.

Results

The P_max (135.6 ± 32.1 ms vs. 116.1 ± 14.1 ms, p = 0.041) and P_d (33.6 ± 7.9 vs. 28.6 ± 5.3, p = 0.006) values were significantly reduced after ARNI treatment. Furthermore, ARNI treatment was associated with an improvement in MLWHFQ scores (31.2 ± 6.2 ms vs. 23.2 ± 7.0 ms, p < 0.001) and with a reduction in NT-proBNP values (1827.3 ± 1287.3 pg/ml vs. 1074.4 ± 692.3 pg/ml, p < 0.001). There were moderately positive correlations between the reduction in P_d and the improvement in MLWHFQ scores (r = 0.408, p = 0.031) and the reduction in NT-proBNP values (r = 0.499, p = 0.007)

Conclusion

Switching to ARNI treatment alters P_d and P_max favorably in patients with HFrEF. The reduction in atrial inhomogeneous conduction assessed by P_d was correlated with clinical improvement and reduced NT-proBNP levels in patients with HFrEF.

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Titel: Effects of angiotensin receptor neprilysin inhibition on P-wave dispersion in heart failure with reduced ejection fraction
verfasst von: Assoc. Prof. Sercan Okutucu, MD, FESC, FACC, FAHA, FAPSC
Sefik Gorkem Fatihoglu, MD
Cengiz Sabanoglu, MD
Nurbanu Bursa
Begum Yetis Sayin, MD
Associate Professor Hakan Aksoy, MD
Professor Ali Oto, MD, FESC, FACC, FHRS, FISHNE
Publikationsdatum: 03.12.2019
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe Sonderheft 1/2021
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-019-04872-4

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