Experience with the use of valsartan/sacubitril in patients with chronic heart failure in combination with type 2 diabetes mellitus and paroxysmal atrial fibrillation

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Abstract

Background. About 33.5 million patients suffer from atrial fibrillation (AF); which causes complications and increases mortality and disability. Compared to therapy with angiotensin-converting enzyme inhibitor and sartans; an angiotensin neprilysin receptor inhibitor (ARNI) may further improve the prognosis of cardiovascular diseases such as chronic heart failure (CHF). However; the relationship between ARNI therapy and the risk of AF recurrence is currently unknown.

Objective. Evaluation of the effect of the valsartan/sacubitril (V/S) combination on the occurrence of episodes of AF in patients with CHF and type 2 diabetes mellitus (DM2).

Methods. 53 patients with DM2 and paroxysmal AF were followed-up. All patients had CHF II–III functional classes (FC) with left ventricular (LV) ejection fraction (EF) <50%. Standard lifestyle changes were recommended; and appropriate glucose-lowering and organ-protective therapy was prescribed for all patients. The patients were divided into 2 groups: group 1 (19 patients; received V/S at a starting dose of 100 mg/day; followed by an increase to 400 mg/day) and group 2 (34 patients; received losartan at the starting dose of 50 mg/day; increasing to 150 mg/day). Before inclusion in the study and after 11.3 (5.2) months of follow-up; clinical and laboratory studies were carried out; echocardiography (Echo-CG) with tissue Doppler (TD) and Holter monitoring (HM) of the electrocardiogram (ECG) were performed over time.

Results. All patients tolerated the prescribed treatment satisfactorily. During the last 5 months before the end of follow-up period; episodes of AF occurred significantly less frequently in patients of group 1 compared to patients of group 2: 4 (21.1%) versus 17 (50%); P<0.05. In both groups; during follow-up period; a significant decrease in the left atrium volume index; functional class of CHF; glycated hemoglobin level; an increase in LVEF; and an improvement in LV diastolic function (according to Echo-CG data with TD) were noted. Moreover; these positive changes were significantly more pronounced in group 1 compared to group 2 (P<0.05).

Conclusion. The V/S combination compared with losartan in patients with CHF in combination with DM2 and paroxysmal AF was cha-racterized by satisfactory tolerability; was associated with a decrease in the frequency of arrhythmia relapses; and also caused more significant favorable changes in clinical; laboratory and instrumental parameters.

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About the authors

A. G. Ignatenko

M. Gorky Donetsk State Medical University

Email: prikav@yandex.ru
ORCID iD: 0000-0003-0562-3509
Russian Federation, Donetsk

A. E. Bagriy

M. Gorky Donetsk State Medical University

Email: prikav@yandex.ru
ORCID iD: 0000-0002-0295-3724
Russian Federation, Donetsk

Alina V. Prikolota

M. Gorky Donetsk State Medical University

Author for correspondence.
Email: prikav@yandex.ru
ORCID iD: 0000-0002-9128-2511

Cand. Sci. (Med.), Associate Professor at the Department of Therapy n.a. prof.  A.I. Dyadyk, Faculty of Continuous Medical and Pharmaceutical Education

Russian Federation, Donetsk

O. A. Prikolota

M. Gorky Donetsk State Medical University

Email: prikav@yandex.ru
ORCID iD: 0000-0002-2127-6925
Russian Federation, Donetsk

E. S. Mikhailichenko

M. Gorky Donetsk State Medical University

Email: prikav@yandex.ru
ORCID iD: 0000-0001-8625-1406
Russian Federation, Donetsk

I. A. Golodnikov

M. Gorky Donetsk State Medical University

Email: prikav@yandex.ru
ORCID iD: 0000-0001-6866-037X
Russian Federation, Donetsk

O. N. Bagriy

Donetsk Regional Clinical Territorial Medical Association

Email: prikav@yandex.ru
ORCID iD: 0000-0003-1712-2760
Russian Federation, Donetsk

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