Sacubitril/Valsartan Improves Left Atrial and Ventricular Strain and Strain Rate in Patients with Heart Failure with Reduced Ejection Fraction

Abstract

Background: Data on the impact of sacubitril/valsartan (SV) therapy on phasic left atrial (LA) and left ventricular (LV) strain in heart failure with reduced ejection fraction (HFrEF) are limited. The aim of this study was to evaluate changes in two-dimensional speckle tracking (2D-STE) parameters with SV therapy in HFrEF patients. Methods: Prospective evaluation of HFrEF patients receiving optimized medical therapy. Two-dimensional speckle tracking (2D-STE) parameters were assessed at baseline and after 6 months of SV therapy. LA strain and strain rate (SR) in reservoir, conduit, and contraction phases were compared with LV longitudinal, radial, and circumferential strain and SR and stratified according to heart rhythm and HFrEF etiology. Results: A total of 35 patients completed the 6-month follow-up, with a mean age of 59 ± 11 years, 40% in atrial fibrillation, 43% with ischemic etiology, and LVEF of 29 ± 6%. There were significant improvements in LA reservoir, conduit, and contractile strain and SR following SV therapy, particularly among patients in sinus rhythm. There were significant improvements in longitudinal, radial, and circumferential LV function indices. Conclusion: SV therapy in HFrEF was associated with improved longitudinal, radial, and circumferential function, particularly among patients in sinus rhythm. These findings can provide insights into the mechanisms underlying the improvement of cardiac function and help assess subclinical responses to the treatment.

The Improvement of Left Atrial Function after Twelve Weeks of Supervised Concurrent Training in Patients with Heart Failure with Mid-Range Ejection Fraction: A Pilot Study

“…Despite being very preliminary, data of the present study constitute the first demonstration that a nonpharmacological intervention could be effective in improving indices of LA function in HFmrEF. A similar result was recently obtained, in HF with reduced EF, by different research groups using the same pharmacological approach [17,[30][31][32]. In these studies, the administration of sacubitril-valsartan reduced LA size and improved LA reservoir strain and LV GLS, with these benefits typically observed after 6 months of treatment.…”

Impact of Sacubitril–Valsartan Treatment on Diastolic Function and Right Ventricular Function in Patient with Heart Failure with Reduced Ejection Fraction

“…Peak tricuspid regurgitation velocity was found to decrease among participants after treatment, from a mean of 2.41 to 1.99 m/sec., [p=0.00]. Similar findings were found by Brás et al [16] , where the mean tricuspid regurgitation velocity was measured at baseline to be 2.73, and after 6 months to be 2.57. Also, Romano et al [12] detected a similar reduction in mean tricuspid regurgitation velocity [from 2.8 to 2.64].…”

Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study

“…In this regard, some preliminary studies have provided evidences on the possibility of counteracting the LA remodeling process through the improvement of LA functional parameters in different clinical contexts. This goal has been achieved independently through either the administration of sacubitril–valsartan in patients with advanced HF with reduced ejection fraction (HFrEF) ( 13 ) or weight loss in diabetic obese subjects ( 14 ). Exercise training, mainly in the setting of supervised cardiac rehabilitation programs, exerts several favorable effects in patients with ICM, such as it reduces symptoms, enhances exercise tolerance, and ultimately improves the prognosis of these patients ( 15 , 16 ).…”