Effect of Sacubitril/Valsartan or enalapril on left ventricular longitudinal strain in patients with hematologic malignancies after bone marrow transplantation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease Background and Aims Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with enalapril or sacubitril/valsartan could prevent cardiotoxicity. Patients and methods 60 patients (mean age 44,8± 14,1 years old, 34 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive sacubitril/valsartan 24/26 mg bid daily or enalapril 5 mg bid daily or placebo. We measured at baseline, before transplantation, after three and after six months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) Left Ventricular End Diastolic Volume, Left Ventricular End Systolic Volume and Left Ventricular Ejection Fraction (LVEF Simpson’s Method). Results The three treatment groups had similar age, sex, atherosclerotic risk factors and cardiotoxic medication before, and after bone marrow transplantation. Compared to baseline, patients treated with sacubitril/valsartan did not show a deterioration of LV GLS at three and six months follow up (GLS=-20.2 ± 3.1% vs -19.8 ± 3.1%, p = 0.551 vs -19.6 ± 3.2%, p = 0.452, respectively). Similarly, compared to baseline, patients treated with enalapril did not show a deterioration of LV GLS at three and six months follow up (GLS=-20.7 ± 3.0% vs -20.5 ± 2.8%, p = 0.772 vs -20.3 ± 3.2%, p = 0.730, respectively). Conversely, patients treated with placebo, presented a significant impairment of LV GLS, at three and six months follow up (GLS=-20,5 ± 1.9% vs -18.5 ± 2.4%, p = 0.003 vs -18.6 ± 2.9%, p = 0.018, respectively). No significant changes were found in LVEF after treatment with sacubitril/valsartan (57,9 ± 5,6% vs 57,6 ± 6,1%, p = 0,733) or enalapril (59.2 ± 6.3% vs 60.4 ± 7.7%, p = 0.464) vs placebo (60,1 ± 5,6% vs 57,8 ± 6,6%, p = 0,166) at six months follow up. Conclusions Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial deformation six months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction.