Effect of Entresto on Exercise Capacity in Patients with Chronic Symptomatic Systolic Heart Failure
Introduction and Aim of the work: Many angiotensin enzyme inhibitors and angiotensin receptor blockers have been tested regarding exercise capacity in heart failure patients and could not prove a consistent increase in exercise capacity, regarding entresto the available evidence did not cover the effect on exercise capacity, so in this work we are trying to prove that entresto improve exercise capacity. Methods: 19 consecutive Patients with completed follow up, has undergone (6MHWT), at baseline and after 3 months of reaching optimal dose of Entresto and echo Doppler measurement of E/e` ratio, at baseline before starting entresto and 12 weeks after reaching optimal dose of entresto. Results: the age of our patients was 60 11 years, with male female ratio of 11/8, 52.6% were diabetic, 57.9% were hypertensives, 57.9% were ischemic, 89.5% were on maximally tolerated dose of beta blockers and all were on entresto maximally tolerated dose. In our study the mean 6MHWT at baseline was 292 111 meters and at follow up improved to 414 88 meters (42% improvement) with a P value of < 0.001, also in parallel the E/e` ratio at baseline was 14.01 4.89 and decreased at follow up to 9.552.36 with a P value of 0.003, the E and e` changes in baseline to follow up were not significant. Discussion: In comparison to our work Faraudo et al studied 30 patients at baseline and after 3 months of dose optimization similar to our protocol, their 6MHWT was 274 96 meters and improved to 335 100 meters (22% improvement) with a P value of 0.05. Beltran et al, and Sgorbini et al repeated the 6MHWT after 30 days and compared to baseline and showed significant improvement after 30 days. Canu and his group, studied 180 patients and repeated the 6MHWT at 30 days, 3 months, and 6 months and 6MHWT increased from a mean of 461 meters to up 6MHWT. From the all the above we see a consistent increase in exercise capacity of heart failure patients upon the start of entresto therapy whether at one month or at three months, our study is limited by small number of patients and lack of control group, and in the future a larger study could state the clear fact that entresto improve the exercise capacity of chronic systolic heart failure patients. Conclusion: In this pilot study entresto therapy could increase significantly the exercise capacity of chronic systolic heart failure patients. In parallel the E/e` have dropped in the follow up denoting drop in the left ventricular end diastolic pressure which is marker of improvement in heart failure status and consequently improve the exercise capacity.
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