Reverse remodelling by sacubitril/valsartan predicts the prognosis in heart failure with reduced ejection fraction

Abstract

Aims Despite well-established benefits of sacubitril/valsartan for cardiac reverse remodelling and the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), there are some patients with limited therapeutic response, even with optimal therapy. We assessed the treatment response to sacubitril/valsartan in patients with HFrEF, focusing on the association between reverse remodelling and the prognosis. Methods and results Using a retrospective cohort of consecutive patients with HFrEF treated with sacubitril/valsartan, we compared the time trajectory of cardiac function in 415 patients (1258 echocardiograms), according to the occurrence of cardiovascular death and hospitalization for HF during a median follow-up of 19.1 (interquartile range, 10.9-27.6) months. A higher sacubitril/valsartan dose was associated with a better prognosis, whereas advanced age, diabetes, left ventricular (LV) hypertrophy, left atrial enlargement, and pulmonary hypertension were associated with a worse prognosis. Patients without an event (n = 337; 81.2%) showed LV reverse remodelling (LV ejection fraction ≥45% or LV end-systolic volume reduction by 15% from baseline), which was typically observed within 6 months of sacubitril/valsartan treatment. Reverse remodelling achievement was significantly associated with a better prognosis. However, patients without reverse remodelling had a worse prognosis, as poor as that in patients with HFrEF not treated with sacubitril/valsartan. Conclusions In patients with HFrEF treated with sacubitril/valsartan, LV reverse remodelling reflects the treatment response and predicts the prognosis, whereas a lack of reverse remodelling indicates the lack of treatment benefits. Prediction and assessment of reverse remodelling may facilitate the selection of patients with greater benefits by sacubitril/valsartan.

Echocardiographic changes in elderly patients with heart failure with reduced ejection fraction after sacubitril-valsartan treatment

“…It was found that in the overall population, the LVEF increased significantly by the sixth month after taking Sacubitril-Valsartan, while the LVEDD, LEVSD, LAD and LVMI decreased significantly. These results were confirmed by the previous three studies (11)(12)(13). In subgroup analysis, the improvement of heart function in male and NHYA II and III subgroups was more substantial than in women and NYHA IV subgroups.…”

Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan

“…Growing evidence has emerged of the role of S/V in modifying the clinical course of HFrEF patients, through its modulation of neurohormonal imbalance [2]. The effect of S/V on left chambers' remodelling has been previously demonstrated by traditional 2D TTE [1,[3][4][5][6][7]23] and speckle tracking analysis [5]. On the contrary, there is a paucity of data on the impact of S/V on RV dimensions and function, which are based exclusively on 2D echocardiographic parameters [5,9].…”

“…Indeed, in the case of previous myocardial infarction, the LV may undergo profound morphological changes with distortion of its 3D shape, which may be unnoticed by 2D echocardiography [27,28]. Although LV reverse remodelling has been described by 2D TTE at mid-and long-term follow-up after S/V initiation in HFrEF patients [1,[3][4][5][6][7]23], only one study conducted subgroup analyses and found no differences in the 2D LVEF improvement between IHD and non-IHD [29]. Such discrepancy from our results may be ascribed to the short followup (3 months) and the low dose of S/V achieved by patients enrolled in the study by Almufleh et al [29].…”

“…By inhibiting the renin-angiotensin-aldosterone system [2], sacubitril/valsartan (S/V) is proved to ameliorate left ventricular (LV) volumes, LV systolic [1,[3][4][5][6][7] and diastolic function [5,6,8,9], and long-term prognosis in HFrEF [10][11][12][13]. A few studies, conducted on a limited number of cases, demonstrated an improvement in right ventricular (RV) function by two-dimensional (2D) transthoracic echocardiography (TTE) [5,8,9].…”

Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

“…Additionally, we compared the changes in echocardiographic parameters, which are indicative of the response to treatment, and can also translate into prognostic benefits 28 . Improvements in echocardiographic parameters were observed 1–6 months after the initiation of treatment and were maintained until 12–24 months after initiation, suggesting that the early initiation of combination therapy may result in better prognosis in diabetic patients with HFrEF.…”