EFFICACY OF PERINDOPRIL IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION.

Abstract

Background/introduction: Heart failure with reduced ejection fraction (HFrEF) represents a major global health burden, accounting for approximately half of all heart failure cases and characterized by high mortality, frequent hospitalizations, and progressive cardiac remodeling. Angiotensin-converting enzyme (ACE) inhibitors constitute a foundational cornerstone in the therapeutic management of HFrEF. Perindopril is a long-acting ACE inhibitor with a highly favorable safety profile; however, robust clinical data evaluating its specific efficacy in HFrEF cohorts remain scarce.

Aim: To evaluate the therapeutic efficacy, reverse cardiac remodeling, and clinical outcomes of perindopril versus sacubitril/valsartan in patients with HFrEF in routine clinical practice.

Methods: This retrospective cohort study included 214 HFrEF patients (LVEF<40%, mean age 64.8±11.0 years) treated at Tbilisi Heart Center between 2018 and 2025. Patients received GDMT and were divided into two groups: Perindopril (n=118) and Sacubitril/Valsartan (n=96). Clinical, echocardiographic, and biochemical metrics were assessed at baseline (Visit 1), 2-3 weeks (Visit 2), and 3-6 months (Visit 3). Primary endpoints included changes in LVEF and NYHA functional class.

Results: • Both treatment strategies significantly improved LVEF, reduced left ventricular dimensions (LVEDD, LVESD), and decreased pulmonary artery systolic pressure (ANOVA p < 0.01), with major reverse remodeling occurring between Visits 1 and 2. • LVEF increased from 34.3±3.9% to 41.3±7.4% in the perindopril group and from 30.8±5.2% to 33.8±8.1% in the sacubitril/valsartan group. • In multivariable linear regression analysis, treatment group (B=-3.170, p=0.004), baseline LVEF (B=0.381, p=0.005), and de novo heart failure (B=2.966, p=0.005) were independent predictors of follow-up LVEF. • Both cohorts showed significant longitudinal optimization in NYHA functional class (p<0.001). No significant changes in serum potassium or renal function were observed. One-year all-cause mortality did not differ significantly between groups (33.1% vs. 22.9%, p=0.103).

Conclusion: Perindopril therapy is associated with significant clinical improvement, LVEF recovery, and positive reverse cardiac remodeling in patients with HFrEF. Both perindopril and sacubitril/valsartan demonstrate comparable efficacy in reducing cardiac dimensions and optimizing NYHA functional status. Furthermore, perindopril maintains a favorable safety profile with low nephrotoxicity, confirming its potential as an effective therapeutic option in HFrEF management.