IMR Press / RCM / Volume 23 / Issue 7 / DOI: 10.31083/j.rcm2307238
Open Access Review
Sacubitril/valsartan in Heart Failure and Beyond—From Molecular Mechanisms to Clinical Relevance
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1 Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
2 Department of Pharmacology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
3 Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
4 Clinic of Pulmology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
5 Clinic of Cardiology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
6 Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
7 Clinic of Psychiatry, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
8 Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
9 Department of Pathophysiology, 1st Moscow State Medical University IM Sechenov, 119991 Moscow, Russia
10 Department of Human Pathology, 1st Moscow State Medical University IM Sechenov, 119991 Moscow, Russia
*Correspondence: danijela-kckragujevac@hotmail.com (Danijela Djokovic)
Academic Editors: Filippos Triposkiadis and Davide Bolignano
Rev. Cardiovasc. Med. 2022, 23(7), 238; https://doi.org/10.31083/j.rcm2307238
Submitted: 16 February 2022 | Revised: 25 March 2022 | Accepted: 31 March 2022 | Published: 24 June 2022
(This article belongs to the Special Issue State-of-the-Art Cardiovascular Medicine in Europe 2022)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

As the ultimate pathophysiological event, heart failure (HF) may arise from various cardiovascular (CV) conditions, including sustained pressure/volume overload of the left ventricle, myocardial infarction or ischemia, and cardiomyopathies. Sacubitril/valsartan (S/V; formerly termed as LCZ696), a first-in-class angiotensin receptor/neprilysin inhibitor, brought a significant shift in the management of HF with reduced ejection fraction by modulating both renin-angiotensin-aldosterone system (angiotensin II type I receptor blockage by valsartan) and natriuretic peptide system (neprilysin inhibition by sacubitril) pathways. Besides, the efficacy of S/V has been also investigated in the setting of other CV pathologies which are during their pathophysiological course and progression deeply interrelated with HF. However, its mechanism of action is not entirely clarified, suggesting other off-target benefits contributing to its cardioprotection. In this review article our goal was to highlight up-to-date clinical and experimental evidence on S/V cardioprotective effects, as well as most discussed molecular mechanisms achieved by this dual-acting compound. Although S/V was extensively investigated in HF patients, additional large studies are needed to elucidate its effects in the setting of other CV conditions. Furthermore, with its antiinflamatory potential, this agent should be investigated in animal models of inflammatory heart diseases, such as myocarditis, while it may possibly improve cardiac dysfunction as well as inflammatory response in this pathophysiological setting. Also, discovering other signalling pathways affected by S/V should be of particular interest for basic researches, while it can provide additional understanding of its cardioprotective mechanisms.

Keywords
sacubitril/valsartan
heart failure
cardiovascular diseases
cardioprotective mechanisms
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