Background: Sacubitril-valsartan has been shown to improve morbidity and mortality in heart failure patients with reduced left ventricular (LV) ejection fraction (EF). However, there is little data describing the effects of sacubitril-valsartan on LV remodeling or LVEF.
Methods: In this single center retrospective study, we assessed all patients who were switched to sacubitril-valsartan at our Heart Function Clinic between Dec 4, 2015 and March 31, 2017. Those who had baseline and follow-up echocardiograms were included in this analysis. Changes in LV size and function as well as functional capacity were assessed.
Results: During the study period, a total of 129 patients were switched to sacubitril-valsartan. Of those, 43 patients had pre- and post- echocardiograms with an average age of 58.0 ± 12.9 years. 11.6% were NYHA I, 69.8% NYHA II, and 18.6% NYHA III. Baseline medical treatment with β-blockers, ACEi/ARB, and MRA were 100%, 98%, and 95%, respectively. The mean percent of target dose of GDMT for β-blockers, ACEi/ARB, and MRA were 96%, 90%, and 86%, respectively. The average starting and attained doses on sacubitril-valsartan were 89.5 mg BID and 192.4 mg BID, respectively. The median time from LV assessment to initiation of sacubitril-valsartan was 177 (IQR 31, 291) days, whereas the median time from initiation of sacubitril-valsartan to LV reassessment was 161 (IQR 119, 248) days. Average LVEF increased from 27.4 ±6.9% to 36.4 ±12.4%, p < 0.001) (Figure 1), whereas LV end-diastolic dimension decreased from 67.6 mm to 65.2 mm (p = 0.01). There was no significant change in NYHA class post initiation of sacubitril-valsartan (Figure 2).
Conclusion: In this single-centre retrospective analysis, switching from ACEi/ARB to sacubitril-valsartan in heart failure patients with reduced LVEF resulted in a significant increase in LVEF of almost 9%. These results, if reproduced, suggests that sacubitril-valsartan is associated with reverse left-ventricular remodeling.