Sacubitril/valsartan versus candesartan in women with heart failure receiving adjuvant therapy for breast cancer - is there any antiarrhythmic effect?

Purpose. To compare the effects of sacubitril/valsartan and candesartan on the occurrence and course of heart arrhythmias in the standard treatment of heart failure (HF) in patients with breast cancer receiving anthracycline antibiotics as part of adjuvant polychemotherapy. Methods. The study involved 127 women aged 53 to 65 who received radical surgical and subsequent treatment for breast cancer in the MAMME clinic in Krasnodar in 2017-2020. Patients were prescribed adjuvant polychemotherapy, including anthracyclines, from 6 cycles. After randomization, standard HF therapy was carried out simultaneously with chemotherapy using sacubitril/valsartan (n=63) or candersartan (n=64). Initially, after the first, third and last courses of special cancer therapy, the heart rate was assessed using standard electrocardiography, 24-hour Holter monitoring of the electrocardiogram, transthoracic echocardiography, a 6-minute walk test were performed, and the level of the N-terminal pro-B type natriuretic peptide and high-sensitivity cardiac troponin I, the Minnesota Quality of Life Questionnaire for patients with chronic HF was completed. Results. According to the 24-hour Holter monitoring of the electrocardiogram, the burden of ventricular premature contraction significantly decreased in the sacubitril/valsartan group (p=0.018), but not in candesartan group (p=0.326). The proportion of patients with persisting episodes of unstable ventricular tachycardia was also significantly reduced in patients randomized to take sacubitril/valsartan (p=0.027), but practically did not change in the candesartan group (p=0.785). Physical exercise tolerance, a 6-minute walk distance, and a quality of life indicator significantly improved only in the sacubitril/valsartan group. According to echocardiography, sacubitril/valsartan improved systolic function of the left ventricle, and candesartan only prevented its decline under the influence of the damaging effects of chemotherapy. Conclusion. The efficacy and safety of treating patients who received cardiotoxic adjuvant chemotherapy for breast cancer, a decrease in the burden of ventricular arrhythmias, noted in the sacubitril/valsartan group, were a consequence of the intensification of treatment for HF. The cardiotoxic effect of anthracyclines can be overcome thanks to the pronounced positive neurohumoral effects of modern pharmacotherapy of HF using sacubitril/valsartan, which leads to a limitation of myocardial remodeling.