Sacubitril/valsartan has an underestimated impact on the right ventricle in patients with sleep-disordered breathing, especially central sleep apnoea syndrome

Background: Sacubitril/valsartan has been demonstrated to significantly improve left ventricular performance and remodelling in patients with heart failure. However, its effects on the right ventricle in patients with chronic heart failure and sleep-disordered breathing (SDB) have not been studied.Aim: To investigate the impact of sacubitril/valsartan treatment on right ventricular function in patients with SDB.Methods: This was a subanalysis of an observational prospective multicentre study involving 101 patients. At inclusion, patients were evaluated by echocardiography and nocturnal ventilatory polygraphy, which allowed patients to be divided into three groups: "central-SDB‿; "obstructive-SDB‿; and "no-SDB‿.Results: After 3 months of sacubitril/valsartan therapy, a positive impact on right ventricular function was observed. In the general population, tricuspid annular plane systolic excursion increased by +1.32 ± 4.74 mm (P = 0.024) and systolic pulmonary artery pressure decreased by –3.1 ± 10.91 mmHg (P = 0.048). The central-SDB group experienced the greatest echocardiographic improvement, with a significant increase in tricuspid annular plane systolic excursion of +2.1 ± 4.9 mm (P = 0.045) and a significant reduction in systolic pulmonary artery pressure of –8.4 ± 9.7 mmHg (P = 0.001).Conclusions: Sacubitril/valsartan improved right ventricular function in patients with heart failure and SDB after only 3 months of treatment. The greatest improvement in right ventricular function was observed in the central-SDB group.