Funding Acknowledgements Type of funding sources: None. Background Myocardial viability particularly hibernating myocardium is one of the critical parameters for the assessment of the long-term prognosis of patients with ischemic etiology heart disease. Purpose of the study was to evaluate the influence of angiotensin receptor neprilysin inhibitor - sacubitril/valsartan on hibernating myocardium in patients with ischemic etiology chronic heart failure with reduced ejection fraction. Material and Methods One hundred and twenty patients with chronic heart failure with reduced ejection fraction (EF<40%) were enrolled in the study (mean age 58.2±14.6 years, male=53%). Patients were divided into two groups by sixty. Group I patients were assigned sacubitril/valsartan while Group II were assigned valsartan in addition to the standard treatment. Hibernating myocardium were assessed with echocardiography with dopamine test. All statistical analysis were assessed using STATA software. Results Ejection fraction and the wall motion score has been improved in both groups from baseline (P<0.05), however when we compared two groups, sacubitril/valsartan group tended to have more positive effect on ejection fraction (from 32.2±8.2% to 43.6±12.4% vs. from 31.7±8.0% to 37.2±10.3%, P<0.05) and the wall motion score (from 2.34±0.5 to 1.92±0.4 vs. 2.36±0.6 to 2.15±0.45, P<0.05) compared to valsartan group. Diastolic and systolic wall thickness has been improved in both groups from baseline (P<0.05), however there were not statistically significant changes between groups (P>0.05). When we analyzed by gender there were not significant changes between male and female (P<0.05). Conclusion Sacubitril/valsartan improves myocardial viability in patients with ischemic etiology chronic heart failure with reduced ejection fraction. Further studies with large amount of patients are required to clarify exact mechanisms.

Funding Acknowledgements Type of funding sources: None. Background Chronic heart failure (CHF) is one of the pressing issues of modern cardiology and is widely discussed lately. Chronic heart failure with reduced ejection fraction (HFrEF) is common and is concerned with poor outcomes. Not only systolic function, but also diastolic function is deteriorated in HFrEF. Thus, we hypothesized the efficacy of angiotensin converting enzyme-neprilysin inhibitors on the diastolic function of patients with HFrEF. Objective Aim of the study was to evaluate the efficacy of angiotensin converting enzyme-neprilysin inhibitor - sacubitril/valsartan on diastolic parameters in patients with CHFrEF. Material and Methods 114 patients with diagnosed HFrEF with NYHA II-III functional class patients had been enrolled in the study. Mean age of the patients was 61.12±14.4 years, male was 53%. Patients randomly were divided into two groups by 57. Group I was provided with sacubitril/valsartan whereas Group II was provided with valsartan. All anthropometric, laboratory and instrumental methods including echocardiography with Doppler were performed at baseline and after the six months of the treatment. All statistical analysis were performed with STATA software. Results Diastolic function was significantly improved after the treatment of sacubitril/valsartan in six months compared to valsartan group (P<0.05). E/e ratio was significantly improved in patients with sacubitril/valsartan compared to valsartan group (P<0.01). Left atrial longitudinal strain was significantly lower in the first group patients than second one was (P<0.001). Even though, isovolumic relaxation time and velocity time integral of the E-A complex have been improved in both groups during the treatment in six months, there have not been observed significant changes between groups (P>0.05). During the follow-up period group I patients have been experienced less hospitalization than group II patients were (P<0.05). Conclusion Sacubitril/valsartan significantly improved diastolic function compared to valsartan in patients with HFrEF. Further studies are required with large amount of patients.

This review article summarizes the reasons, pathophysiological mechanisms, possible clinical features, and the optimal management strategies of patients with chronic heart failure taking into account cardiovascular functional status. In addition, it shows current situation with chronic heart failure in the world, epidemiological status of the problem as well, risk factors contributing to the development of the disease.

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