{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:31:54Z","timestamp":1788294714280,"version":"build-2803163510"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF), which is a common co-morbidity in patients with maintenance hemodialysis (MHD), results in substantial mortality and morbidity. However, there are still no effective therapeutic drugs available for HFpEF currently. Sacubitril\/valsartan has been shown to significantly improve clinical outcomes and reverse myocardial remodeling among patients with heart failure with reduced ejection fraction (HFrEF). The effect of sacubitril\/valsartan in MHD patients with HFpEF remains unclear. Our study was designed to assess the efficacy and safety of sacubitril\/valsartan in MHD patients with HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 247 MHD patients with HFpEF treated with sacubitril\/valsartan were included in this retrospective study. Patients were followed up regularly after medication treatment. The alterations in clinical, biochemical, and echocardiographic parameters before and after taking sacubitril\/valsartan were collected. In addition, the safety of the sacubitril\/valsartan treatment was also assessed. Among those 247 patients with MHD, 211 patients were already in treatment with angiotensin converting enzyme inhibitors (ACEi)\/angiotensin receptor blockers (ARBs) before being treated with sacubitril\/valsartan. We also performed an analysis to compare the differences between the 211 patients who had previously received ACEi\/ARB treatment and the 36 patients who were sacubitril\/valsartan naive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among those 247 patients with MHD, compared with baseline levels, systolic blood pressure (BP) (149.7 \u00b1 23.6 vs. 137.2 \u00b1 21.0 mmHg,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), diastolic BP (90.2 \u00b1 16.1 vs. 84.5 \u00b1 14.1 mmHg,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), heart rate (83.5 \u00b1 12.5 vs. 80.0 \u00b1 8.7 bpm,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), N-terminal B-type natriuretic peptide precursor (NT-proBNP) [29125.0 (11474.5, 68532.0) vs. 12561.3 (4035.0, 37575.0) pg\/ml,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001], and cardiac troponin I [0.044 (0.025, 0.078) vs. 0.0370 (0.020, 0.064) \u03bcg\/L,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009] were markedly decreased after treatment with sacubitril\/valsartan. New York Heart Association (NYHA) functional class showed a notable trend of improvement after 3\u201312 months of follow-up. Echocardiographic parameters including left ventricular posterior wall thickness (LVPWT) (11.8 \u00b1 2.0 vs. 10.8 \u00b1 1.9 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), intraventricular septal thickness in diastole (11.8 \u00b1 2.0 vs. 11.2 \u00b1 2.0 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), left ventricular end-diastolic diameter (53.8 \u00b1 6.9 vs. 51.2 \u00b1 7.1 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), left atrial diameter (LAD) (40.5 \u00b1 6.2 vs. 37.2 \u00b1 7.2 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), left ventricular end-diastolic volume (LVEDV) [143.0 (111.5, 174.0) vs. 130.0 (105.0, 163.0) ml,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001], left ventricular end-systolic volume (LVESV) [57.0 (43.0, 82.5) vs. 48.0 (38.0, 74.0) ml,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001], and pulmonary arterial systolic pressure [39.0 (30.5, 50.0) vs. 28.0 (21.0, 37.5) mmHg,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001] were significantly reduced after initiating the treatment of sacubitril\/valsartan. The parameters of left ventricular diastolic function including E\/A ratio [0.8 (0.7, 1.3) vs. 0.9 (0.8, 1.3),\n                      <jats:italic>P<\/jats:italic>\n                      = 0.008], maximal tricuspid regurgitation velocity [2.7 (2.5, 3.2) vs. 2.4 (2.0, 2.8) m\/s,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001], septal e\u2019wave velocity (8.0 \u00b1 0.6 vs. 8.2 \u00b1 0.5 cm\/s,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001), lateral e\u2019 wave velocity (9.9 \u00b1 0.8 vs. 10.2 \u00b1 0.7 cm\/s,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), E\/e\u2019 [8.3 (6.4, 11.8) vs. 7.2 (6.1, 8.9),\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001], and left atrial volume index (37.9 \u00b1 4.2 vs. 36.4 \u00b1 4.1 ml\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) were significantly improved by sacubitril\/valsartan. Among 211 patients who were already in treatment with ACEi\/ARB and 36 patients who were sacubitril\/valsartan naive, the improvement of cardiac function demonstrated by clinical outcomes and echocardiographic parameters were similar to the previous one of the 247 MHD patients with HFpEF. During the follow-up, none of the patients showed severe adverse drug reactions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study suggested that sacubitril\/valsartan treatment in MHD patients with HFpEF was effective and safe.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2022.955780","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:43:45Z","timestamp":1667954625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Effects of sacubitril\/valsartan in ESRD patients undergoing hemodialysis with 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