Background The effects of sacubitril/valsartan in patients with chronic heart failure with reduced ejection fraction (HFrEF) were recently reported. However, the hemodynamic impact of this well-established treatment in patients with HFrEF has been poorly systematically researched. Aim We aimed to investigate the hemodynamic effects of sacubitril/valsartan among patients with HFrEF. Methods Between 2016 and 2020, we retrospectively collected data for patients with HFrEF treated at the University Medical Center Mannheim, Germany. Data for 240 patients with HFrEF were available. We systematically analyzed echocardiographic parameters, all-cause hospitalization, and congestion rate. Results The left ventricular ejection fraction (LVEF) improved from a median (minimum; maximum) of 28% (3; 65) before initiation of sacubitril/valsartan to a median of 34% (13; 64) at 24-month follow-up ( p < 0.001). Systolic pulmonary atrial pressure (PAPsys) decreased from a median of 30 mmHg (13; 115) to 25 mmHg (20; 80) at 24-month follow-up ( p = 0.005). The median (minimum; maximum) tricuspid annular plane systolic excursion improved from 17 mm (3; 31) at baseline to 20 mm (9; 30) at 12-month follow-up ( p = 0.007). The incidence of severe and moderate mitral, tricuspid, and aortic valvular insufficiency improved after treatment. Hospitalization and congestion rates reduced at 24-month follow-up. The mortality rate in echocardiographic and functional nonresponders was higher than in responders (12.1 vs. 5.2%; p = 0.1 and 11.3 vs. 3.1%; p = 0.01, respectively). Conclusion Follow-up 24 months after starting treatment with sacubitril/valsartan revealed sustained improvements in echocardiographic parameters, including LVEF, PAPsys, and cardiac valvular insufficiency. Rates of all-cause hospitalization and congestion had decreased significantly at follow-up. The mortality rate was higher in echocardiographic and functional nonresponders. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-022-00525-w.

AimTo compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin‐receptor neprilysin inhibitor (ARNI).MethodsWe gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m2; n = 116, ≥ 30 kg/m2; n = 92). Clinical outcomes, including mortality rate, all‐cause hospitalizations and congestion, were systematically analysed.ResultsAt the 12‐month follow‐up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m2 vs. 5.6% in BMI ≥ 30 kg/m2; P = .76). All‐cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m2 vs. 57.6% in BMI ≥ 30 kg/m2; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12‐month follow‐up (52.2% in BMI < 30 kg/m2 vs. 53.7% in BMI ≥ 30 kg/m2; P = .73). Obese patients experienced more congestion compared with non‐obese patients at follow‐up, without statistical significance (6.8% in BMI < 30 kg/m2 vs. 15.5% in BMI ≥ 30 kg/m2; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non‐obese compared with obese patients at the 12‐month follow‐up (from 26% [3%‐45%] [min.‐max.] vs. 29% [10%‐45%] [min.‐max.] [P = .56] to 35.5% [15%‐59%] [min.‐max.] vs. 30% [13%‐50%] [min.‐max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non‐sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non‐obese than in obese patients after initiation of sacubitril/valsartan at the 12‐month follow‐up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23).ConclusionsThe incidence of congestion in obese patients was higher compared with non‐obese patients. LVEF improved significantly more in non‐obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12‐month follow‐up.

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