The Study on Effects of Sacubitril-Valsartan on Left Ventricular Ejection Fraction, Myocardial Biomarker, and Myocardial Remodeling in Patients with Heart Failure with Reduced Ejection Fraction.

Abstract

Background: Left ventricular ejection fraction (LVEF) is widely used to assess cardiac function but primarily reflects volumetric changes rather than intrinsic myocardial mechanics. Sacubitril/Valsartan, an angiotensin receptor-neprilysin inhibitor, has demonstrated significant benefits in heart failure with reduced ejection fraction (HFrEF). However, its effect on LVEF and left ventricular (LV) torsional dynamics remains insufficiently explored.

Materials and methods: This prospective study enrolled 100 patients with HFrEF. Baseline evaluation included clinical history, physical examination, and laboratory parameters (body mass index, blood pressure, renal function, lipid profile, and electrolytes). Echocardiographic assessment - conventional and speckle-tracking - was performed at baseline, 3 months, and 6 months to measure LVEF, LV rotation, and torsion.

Results: Participants had a mean age of 51.5 years, and 30% had diabetes. At baseline, the median LVEF was 35.5%, which improved to 40.6% at 6 months (interquartile range (IQR) =5.1; P < 0.01), indicating significant reverse remodeling. The LV end-diastolic index decreased from 57.5 to 52.1 (IQR = 5.4; P < 0.01), and the end-systolic index (LVESi) decreased from 39.0 to 34.4 (IQR = 4.6; P < 0.01). LV mass showed an IQR of 27 (246.9-273.9). N-terminal pro B-type natriuretic peptide levels demonstrated a marked reduction, with an IQR of 1442.4 (1030.6-2473). These findings collectively reflect significant structural and functional improvement over the 6-month follow-up.

Conclusion: Sacubitril/Valsartan therapy improves LVEF and LV structural dynamics in HFrEF patients, supporting its role as a superior alternative to enalapril. These findings align with evidence of approximately 20% relative risk reduction in sudden cardiac death and heart failure-related mortality among patients with an ejection fraction <40% and elevated natriuretic peptides.