Background

A possible positive effects in diabetes patients treated with sacubitril/valsartan on outcome and echocardiography parameters is not well studied yet.

Aims

The aim of the present study was to compare the impact of sacubitril/valsartan on life-threatening arrhythmias, atrial fibrillation, different echocardiography parameters, and congestion rate in patients suffering from HFrEF according to the diagnosis diabetes mellitus or no diabetes mellitus.

Methods

Consecutive 240 patients with HFrEF from 2016-2020 were treated with sacubitril/valsartan and separated to concomitant diabetes mellitus (n=87, median age 68 years interquartile range (IQR) [32-87]) or no diabetes mellitus (n=153, median age 66 year IQR [34-89]). Different co-morbidities and outcome data were evaluated over a follow-up period of 24 months.

Results

Over the follow-up of 24 months several changes were noted in both subgroups: median left ventricular EF increased significantly in non-diabetes  (27% IQR [3-44] at baseline to 35% IQR [13-64]; p<0.001), but not in diabetic patients  (29% IQR [10-65] at baseline to 30% IQR [13-55]; p=0.11). Accordingly, NT-proBNP and troponin-I levels decreased significantly in non-diabetes patients (NT-proBNP from median 1445 pg/ml IQR [12.6-74676] to 491 pg/ml IQR [13-4571]; p<0.001, troponin-I levels from 0.099 ng/ml IQR [0.009-138.69] to 0.023 ng/ml IQR [0.006-0.635]; p<0.001), but not  in diabetic patients (NT-proBNP from 1395 pg/ml IQR [100-29924] to 885 pg/ml IQR [159-4331]; p=0.06, troponin-I levels from 0.05 ng/ml IQR [0.013-103.0] to 0.020 ng/ml IQR [0.015-0.514]; p=0.27). No significant change of laboratory parameters e. g. glomerular filtration rate, potassium level and creatinine levels were found in diabetes or non-diabetes patients. Comparing further echocardiography data e. g. left atrial surface area, right atrial surface area, E/A ratio did not show a significant change either in the diabetes or non-diabetes group. However, the tricuspid annular plane systolic excursion was significantly increased in non-diabetes mellitus patients (from 17 mm IQR [3-31] to 18 mm [2.5-31]; p=0.04), and not in diabetic s patients (17.5 mm IQR [8-30] to 18 mm IQR [14-31]; p=0.70); the systolic pulmonary artery pressure remained unchanged in both groups. During follow-up a similar rate of ventricular tachyarrhythmias were observed in both groups. The congestion rate decreased significantly in both groups, in diabetes patients (44.4% before sacubitril/valsartan and 13.5% after 24 months treatment; p= 0.0009) and in non-diabetic patients (28.4% before sacubitril/valsartan and 8.4% after 24 months treatment; p=0.0004). The all-cause mortality rate was higher in patients with diabetes mellitus as compared to those without diabetes (25% versus 8.1%; p<0.01).

Conclusions

Sacubitril/valsartan reverses cardiac remodeling in non-diabetes patients. However, it reduces the congestion rate in diabetes and non-diabetes patients. The rate of ventricular tachyarrhythmias were similar in DM compared to non-DM over follow-up. The mortality rate remained to be over follow-up higher in diabetes patients compared to non-diabetes, however lower compared to published data on diabetes and concomitant HFrEF not treated with sacubitril/valsartan.