Abstract: PUB208
A Combined Effect of Sacubitril/Valsartan and Evolocumab on Chronic Heart Failure in an ESRD Patient
Session Information
Category: Trainee Case Report
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Aung, Htun M., Interfaith Medical Center, Brooklyn, New York, United States
- Thida, Aye M., Woodhull Medical and Mental Health Center, Brooklyn, New York, United States
- Mon, Myat Ei, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Khine, Phyo Wai, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Zin, May Thu, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Win, Banya Myo, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Hla, Kyaw, Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
- Swan, Alexander M., Nephrology Hypertension Renal Transplant & Renal Therapy, LLC., Avenel, New Jersey, United States
Introduction
End-stage renal disease (ESRD) patients generally have underlying risk factors for coronary artery disease and heart failure (HF) such as hypertension and diabetes mellitus. In fact, chronic HF is highly prevalent and is one of the leading causes of death in these patients. We report a combined effect of sacubitril/valsartan and evolocumab on chronic HF in an ESRD patient.
Case Description
A 63-year-old man with a history of chronic HF for 3 years, along with hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease status post coronary artery bypass graft with multiple stents, and ESRD on hemodialysis, presented with worsening dyspnea over 2 months (NYHA Class IV). His medication list included enalapril, valsartan, carvedilol, clonidine, amlodipine, hydralazine, isosorbide mononitrate, ranolazine, aspirin, warfarin, amiodarone, erythropoietin, rosuvastatin, sevelamer, linagliptin, and insulin. An echocardiogram revealed an ejection fraction (EF) of 15%. He was placed on a cardiac transplant waiting list after receiving an implantable cardioverter defibrillator. Meanwhile, enalapril and valsartan were replaced by sacubitril/valsartan for chronic HF, and evolocumab was added to reduce the risk of myocardial infarction. During an initial follow-up for 10 months, his dyspneic symptoms improved significantly to NYHA Class I. An echocardiogram later revealed an EF of 60%. He was followed up for 4 years without any hospitalizations, worsening of HF, or side effects of the medications such as hypotension, hyperkalemia, and nasopharyngitis.
Discussion
Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has multiple mechanisms of action and is known to reduce the risk of cardiovascular death and HF hospitalization in patients with chronic HF with reduced EF. Besides, evolocumab, a PCSK9-inhibitor antibody, is known to promote plaque regression and stabilization. The combined use of sacubitril/valsartan and evolocumab in our patient for 10 months resulted in an improvement of his EF from 15% to 60%, most likely due to a significant improvement of coronary blood flow with a recovery of hibernating ischemic myocardium. Therefore, additional studies are highly recommended to explore the beneficial effect of these medications used in combination.
