Effect of Sacubitril-Valsartan on Estimated Pulmonary Artery Systolic Pressure in Patients With Heart Failure With Reduced Ejection Fraction Heart Failure

September 5, 2026 updated by: Mennatullah Nasser, Aswan University

Effect of (Sacubitril-Valsartan) Drug on Estimated Pulmonary Artery Systolic Pressure

Evaluate effect of Sacubitril-Valsartan on estimated pulmonary artery systolic pressure in patient with reduced ejection fraction heart failure

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Worldwide, the burden of heart failure has increased to an estimated 23 million people, and approximately 50% of cases are heart failure with reduced ejection fraction (HFrEF). Heart failure is a clinical syndrome characterized by dyspnea or exertional limitation due to impairment of ventricular filling or ejection of blood or both.

Heart failure with reduced ejection fraction HFrEF occurs when the left ventricular ejection fraction (LVEF) is 40% or less and is accompanied by progressive left ventricular dilatation and adverse cardiac remodeling. Assessment for heart failure begins with obtaining a medical history and physical examination. Also central to diagnosis are elevated natriuretic peptides above age- and context-specific thresholds and identification of left ventricular systolic dysfunction with LVEF of 40% or less as measured by echocardiography. Treatment strategies include the use of diuretics to relieve symptoms and application of an expanding armamentarium of disease-modifying drug and device therapies.

The Pulmonary hypertension definition has been changed recently to include mean Pulmonary artery pressure, 20 mm Hg, and Pulmonary vascular resistance, 2.0 WU, for distinguishing each of the hemodynamic Pulmonary hypertension subgroups: isolated precapillary, combined precapillary/postcapillary, and isolated postcapillary Pulmonary hypertension.

The goals of therapy of heart failure with reduced ejection fraction are to reduce morbidity (ie, reduce symptoms, improve health-related quality of life and functional status, and decrease the rate of hospitalization), and to reduce mortality.

Attempts to treat PH in HFpEF-PH have resulted in a succession of failures, despite approaching this problem from different pathobiological angles. The endothelin receptor antagonist bosentan, which is effective in pulmonary arterial hypertension, has failed in HFpEF-PH.3 The potent phosphodiesterase type 5 inhibitor sildenafil increases cyclic guanosine monophosphate (cGMP) levels, causing endogenous nitric oxide-mediated vasodilatation in both systemic and pulmonary vasculature. Despite the initial positive trial in the field reported by Guazzi et al., other attempts have failed to show a reduction in pulmonary artery pressure (PAP) or improvement in other haemodynamic parameters in HFpEF-PH. Increased cGMP levels by oral soluble guanylate cyclase stimulators also increase cGMP levels but do not affect PAP, pulmonary vascular resistance, or transpulmonary pressure gradient. Lastly, direct NO donors were examined in the INDIE-HFpEF (Inorganic Nitrite Delivery to Improve Exercise Capacity in Heart Failure with Preserved Ejection Fraction) trial but resulted in no benefit in terms of exercise capacity, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, New York Heart Association (NYHA) functional class, diastolic function, or N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.

Management of heart failure with reduced ejection fraction HFrEF includes management of the cause of heart failure and associated conditions, monitoring, preventative care, care coordination, education and support for heart failure self-management (including lifestyle modification and daily monitoring), pharmacologic therapy, cardiac rehabilitation, palliative care, device therapy (including cardiac resynchronization therapy, implantable cardioverter defibrillator, and mechanical circulatory support [eg, LV assist device]) and cardiac transplantation .

The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) is a particulate guanylyl cyclase activator that increases natriuretic peptides, which signal through cGMP and exert potent antimitogenic and vasodilatory effects.

Sacubitril/valsartan is the latest "disease-modifying drug" approved for the management of patients with heart failure with reduced ejection fraction (HFrEF) In addition to a reduction in the rate of mortality and hospitalization, both randomized clinical trials and real-life studies have shown that sacubitril/valsartan induced the "reverse remodeling" of the left ventricle (LV), with a reduction in the ventricular volumes, an increase in the ejection fraction (EF) [4,5], an improvement in the diastolic function and a reduction in the degree of functional mitral regurgitation.

In 2022 paper was published on the effect of Sacubitril/valsartan on pulmonary artery pressure in patients with heart failure with preserved function and shows these results Sacubitril/valsartan significantly reduced mean pulmonary artery pressure in patients with heart failure with preserved ejection fraction "HFpEF", independent of loop diuretic management, together with improvement in functional capacity, lung congestion, and quality of life. Sacubitril/valsartan may be a therapeutic alternative in HFpEF-PH .

In this study will be conducted to estimate the effect of (valsartan-sacubitril) on pulmonary artery systolic pressure in patient with HFrEF We will assume a research question which will be to what extent the use of (valsartan-sacubitril) does started from (50 mg bid to 200 mg bid) will cause reducing in pulmonary artery systolic pressure.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
59

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Aswān, Egypt
        • Faculty of medicine- Aswan university

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients aged more than 18 years .
  • Diagnosed with HFrEF defined as those with an EF ≤40% .

Exclusion Criteria:

  • Patients < 18 years old

    • Patients with severe renal disease (i.e., estimated glomerular filtration rate according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation ≤30 mL/min/1.73 m2),
    • Patients with moderate-severe liver disease (i.e., a Child-Pugh score ≥7),
    • Patients with severe chronic obstructive pulmonary disease (i.e., Global Initiative for ---Chronic Obstructive Lung Disease class ≥3), History of acute pulmonary embolism
    • History of prior heart surgery with pericardial incision.
    • Pregnancy and lactation.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: HFrEF patients on Sacubitril-Valsartan dose 24/26
Number of cases were 29 patients with reduced ejection fraction heart failure although being on 4 pillars of heart failure treatment " beta blockers, MRA, SGLT2 inhibitors and ACE inhibitor", replacement of ACEI with Sacubitril-Valsartan with dose 24mg/26mg was done with continuation on the same other anti-failure treatments
Drug: SACUBITRIL - VALSARTAN (formerly LCZ696, ENTRESTO®)
sacubitril-Valsartan is ARNI that is one of the pillars of heart failure treatment, here we study its effect on estimated pulmonary artery systolic pressure and studying its effect on relieving elevated pulmonary pressure symptoms.
Active Comparator: HFrEF patients on Sacubitril-Valsartan dose 49/51
Number of cases were 30 patients with reduced ejection fraction heart failure although being on 4 pillars of heart failure treatment " beta blockers, MRA, SGLT2 inhibitors and ACE inhibitor", replacement of ACEI with Sacubitril-Valsartan with dose 49mg/51mg was done with continuation on the same other anti-failure treatments
Drug: SACUBITRIL - VALSARTAN (formerly LCZ696, ENTRESTO®)
sacubitril-Valsartan is ARNI that is one of the pillars of heart failure treatment, here we study its effect on estimated pulmonary artery systolic pressure and studying its effect on relieving elevated pulmonary pressure symptoms.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Effect of Sacubitril-Valsartan on ePASP on patients with HFrEF
Time Frame: 1 year
patients has been followed up by assessing echocardiography assessment of estimated PASP
1 year

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
comparison of effect of doses of sacubitril valsartan on ePASP
Time Frame: 1 year
compare of the effect of different doses of Sacubitril Valsartan 24/26 and 46/51 on estimated pulmonary artery systolic pressur
1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Aswan University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
July 5, 2025

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 5, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 12, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 12, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 5, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
September 11, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 11, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 5, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Sacubitril valsartan un PASP

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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