Authors:

M Abellas Sequeiros¹ , S Del Prado¹ , G Alonso Salinas¹ , A Lorente Ros¹ , JM Vieitez Florez¹ , JL Moya Mur¹ , A Garcia Martin¹ , JJ Jimenez Nacher¹ , C Fernandez Golfin¹ , JL Zamorano Gomez¹ , ¹University Hospital Ramon y Cajal de Madrid - Madrid - Spain ,

Introduction:

Based on the PARADIGM HF trial, sacubitril-valsartan has been included in ESC guidelines for the treatment of chronic heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitor has demonstrated to improve left ventricular ejection fraction (LVEF). Is LVEF the only parameter modified?

Methods:

To answer this question, a series of patients with HFrEF attending the advanced heart failure unit who initiated sacubitril-valsartan was prospectively assessed. Aetiology and baseline characteristics were collected. LVEF and ventricular volumes  were evaluated by transthoracic echocardiogram before and after 6 and 12-month treatment. T- test was conducted for the comparison of paired data.

Results:

Eighty-four patients initiated sacubitril-valsartan. Patients with drug discontinuation or without echocardiogram before and 6-12months after therapy were excluded. Seventy patients were evaluated. Mean age was 73 years old; 58 (83%) patients were men and 54% had ischaemic aethiology. 53% had atrial fibrillation and 54% were diabetic. Mean LVEF was 31,1% and median estimated glomerular filtration rate was 65,4 ml/min. Regarding to optimal medical treatment: 97% were on angiotensin-converting-enzyme inhibitor, 91% beta-blocker and 77% were receiving a mineralocorticoid-receptor antagonist.

Left ventricular ejection fraction significantly improved after 6-month treatment (31,1±4,8 vs 40,7±10,2; p<0,001). Lower left ventricular end systolic (109,2±41,4 vs 83,0±47,2; p=0,006) and end diastolic volumes (163,2±57,9 vs 136,5±57,1; p=0,021) were described. There is a tendency to support these observations also after 12 months: LVEF remained lower (p= 0,003), as well as left ventricular end systolic volume (p=0,058).

Conclusions:

Neprilysin inhibition has a beneficial effect on ventricular structure, improving not only ventricular volumes, but also ejection fraction. Longer follow-up periods need to be assess, as this improvement might change therapeutic approaches based on LVEF, for example, the indication of cardiac resynchronization therapy.