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Recovery of left ventricular dysfunction after Sacubitril/valsartan: predictors and managements

Session Poster Session 3

Speaker Hung-Yu Chang

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : H-Y Chang (Taipei,TW), C-W Hsieh (Taipei,TW), M-C Fong (Taipei,TW), A-N Feng (Taipei,TW), K-C Huang (Taipei,TW), W-T Lai (Taipei,TW), W-H Yin (Taipei,TW)

H-Y Chang1 , C-W Hsieh1 , M-C Fong1 , A-N Feng1 , K-C Huang1 , W-T Lai1 , W-H Yin1 , 1Cheng-Hsin General Hospital - Taipei - Taiwan, Province of China ,



Current heart failure (HF) guidelines give class I, level of evidence B recommendation to replace renin-angiotensin system (RAS) blockers with sacubitril/valsartan in patients with chronic symptomatic HF with reduced ejection fraction (HFrEF) despite optimal treatment. However, data regarding recovery of left ventricular function after sacubitril/valsartan treatment and how to manage these patients remained sparse.


We consecutively enrolled 432 HFrEF patients treated with sacubitril/valsartan between January and December 2017. All patients underwent routine echocardiographic measurement. Baseline characteristics were collected and compared between patients with had recovery of LVEF = 50% (HFrecEF) and patients without recovery of LVEF. Among patients with HFrecEF, serial echocardiographic studies and clinical outcomes were compared between patients with different treatment strategies (Maintenance and Taper Group).


During treatment period, 68 (15.7%) patients had LVEF = 50%. After multivariate analysis, recovery of left ventricular dysfunction after sacubitril/valsartan treatment was associated with non-ischemic etiology of HF (odds ratio 3.05; 95% CI 1.63 to 5.70; p<0.001), smaller baseline left ventricular end-diastolic diameter (odds ratio 0.92 per decrease of 1 mm; 95% CI 0.89 to 0.95; p<0.001) and initial daily dosage of sacubitril/valsartan = 100mg (odds ratio 2.70; 95% CI 1.30 to 5.62; p=0.008). Among these 68 HFrecEF patients, 42 patients continued to receive the same dosage of sacubitril/valsartan, whereas 26 patients received either tapering dose of sacubitril/valsartan or switched from sacubitril/valsartan to RAS blockers. Follow-up echocardiography showed that patients in the Maintenance Group had higher LVEF and less likely to have deterioration of LVEF than those in the Taper Group (LVEF 55.4±6.3% vs. 47.3±13.6%, p=0.007; ?LVEF 0.5±5.8% vs. -5.9±11.4%, p=0.013). Unplanned hospitalization for HF tends to occur in the Taper group than the Maintenance group (15.4% vs. 2.4%, p=0.067).


Non-ischemic etiology of HF, smaller baseline left ventricular end-diastolic diameter and higher initial dosage of sacubitril/valsartan could predict a better recovery of left ventricular dysfunction. In HFrecEF patients, decreasing dosage of sacubitril/valsartan or switching from sacubitril/valsartan to RAS blockers were associated with re-deterioration of heart function.

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