Reverse Remodeling Effects of Sacubitril-Valsartan: Structural and Functional Optimization in Stage C Heart Failure

Abstract

BackgroundSacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, reduces all-cause mortality as well as the rate of heart failure hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to elucidate the benefits of initiating sacubitril-valsartan on ventricular remodeling in patients previously optimized on guideline directed medical therapy. MethodsIn this prospective, single-arm longitudinal study, 40 patients with HFrEF who were optimized on guideline-directed medical therapy were transitioned to sacubitril-valsartan. The primary end-point was the change in left ventricular (LV) volume at 1 year as assessed by three dimensional transthoracic echocardiography. Other echocardiographic endpoints included change in LV function and change in right ventricular (RV) size and function. ResultsThe mean age was 55 ± 12 years and 63% were male. At 1 year, LV end-diastolic volume decreased from 242 ± 71 to 157 ± 57 ml (p <0.001) with a corresponding increase in LV ejection fraction from 32 ± 7 to 44 ± 9 % (p <0.001). RV end-diastolic volume decreased from 151 ± 51 to 105 ± 45 ml (p <0.001). While RV ejection fraction did not change (51 ± 8 vs 51 ± 10; p = 0.35), RV GLS improved from -14.9 ± 3.4 % to -19.3 ± 4.3 % (p <0.001) ConclusionWhen added to standard medical therapy for heart failure, sacubitril-valsartan induces significant remodeling of both the right and left ventricles as assessed by 3D echocardiography.