Impact of Sacubitril/Valsartan on Cardiac Autonomic Function Assessed Using Physiological Data from Implantable Cardioverter-Defibrillators
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background/Objectives: Sacubitril/Valsartan is a cornerstone therapy to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the effect of Sacubitril/Valsartan on cardiac autonomic balance using physiological sensor data obtained from implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Methods: This observational study involved 54 ICD and CRT-D patients who initiated Sacubitril/Valsartan therapy to treat HFrEF. The evaluated key parameters included heart rate variability (HRV), 24 h mean heart rate (24 h-HR), and nocturnal heart rate (nHR). Device electrical parameters and ventricular arrhythmias were also assessed. The data were collected by remote monitoring and averaged over a 7-day window at baseline (before treatment) and at 3 and 12 months after treatment initiation. Results: Sacubitril/Valsartan significantly improved HRV at 3 months (from 78.6 ms [interquartile range: 54.2–104.6] to 80.8 ms [60.8–108.0]; p = 0.041), reduced 24 h-HR (from 73.2 bpm [67.3–77.7] to 69.9 bpm [64.2–75.7]; p = 0.016), and reduced nHR (from 63.0 bpm [58.1–70.0] to 60.4 bpm [56.0–68.6]; p = 0.028). No significant changes in HRV, 24 h-HR, and nHR were observed between 3- and 12-month follow-up. The device electrical parameters were not influenced by the treatment. While the overall ventricular arrhythmia burden did not change post-treatment, patients with pre-treatment arrhythmias experienced a significant reduction in episodes from 2.97 (pre-treatment) to 0.82 (post-treatment) events per 100 patient years (p = 0.008). Conclusions: Sacubitril/Valsartan therapy in HFrEF patients was associated with statistically significant changes in cardiac autonomic indices, including a small increase in HRV and a slight reduction in heart rate, mainly during the first three months of treatment.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm15020719
Authors: Lucy Barone, Domenico Sergi, Giampiero Maglia, Luca Bontempi, Marzia Giaccardi, Matteo Baroni, Claudia Amellone, Antonio Curnis, Giuliano D’Alterio, Davide Saporito, Paolo Vinciguerra, Simone Cipani, Patrizio Mazzone, Massimo Giammaria, Gianfranco Mitacchione, Daniele Masarone, Francesca Fabbri, Andrea Vannelli, Irene Baldassarre, Martina Del Maestro, Daniele Giacopelli, Eduardo Celentano, Gabriele Zanotto, Francesco Barillà
Institutions: Policlinico Tor Vergata, Fondazione Stella Maris, Azienda Ospedaliera Bolognini Seriate, Meyer Children's Hospital, Ospedale Santa Maria Annunziata, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Ospedale Maria Vittoria, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Ospedale Monaldi, Ospedale Infermi di Rimini, Humanitas Gavazzeni, Azienda ULSS 9 Scaligera, Saint Camillus International University of Health and Medical Sciences
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W7124289597