Restored Left Ventricular Mechanical Synchrony in Heart Failure with Reduced Ejection Fraction and Left Ventricular Dyssynchrony: Myocardial Work Indices Analysis.

Abstract

Left ventricle (LV) remodeling consists of structural and electrical remodeling of LV which leads to ventricular systolic dysfunction and LV segment contraction dyssynchrony in heart failure with reduced ejection fraction (HFrEF). The case is a 75-year-old woman who presented with acute decompensated heart failure (HF) and severely reduced left ventricular (LV) systolic function and LV dyssynchrony. We administered guideline-directed medical therapy (GDMT) for HF including sacubitril/valsartan. We evaluated LV systolic function and myocardial work index (MWI) after 12-month GDMT and found a significant improvement of all LV systolic function and MWI parameters along with re-synchronization of LV segment peak systolic strain. We observed none of the HF hospitalization periods and hyperkalemia events in the follow-up time. This report also describes the efficacy of sacubitril/valsartan to induce LV structural and restore LV synchrony. We present a case of severe HFrEF with LV dyssynchrony with low global work efficiency and high global wasted work. After 12-month GDMT for HFrEF, we observed a significant improvement in LV systolic function with LV segment re-synchronization. It is hypothesized the possibility of medication-induced LV mechanical synchrony restoration.