Impact of early in-hospital initiation of sacubitril/valsartan on left ventricular reverse remodelling in acute heart failure.

Aims: The effect of initiating sacubitril/valsartan (Sac/Val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear. This study aimed to assess the impact of Sac/Val on LV remodelling in patients in whom Sac/Val was initiated during AHF hospitalization.

Methods and results: This study was a sub-analysis of the Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy (control). Among the full analysis set of the PREMIER study, this analysis included 206 patients [mean age, 73 years; 64 females (31.1%)], who had available echocardiographic data. The Sac/Val group (n = 94) showed significantly improved LV function and morphological parameters at 8 weeks. Compared with the control group (n = 112), preload-dependent parameters improved significantly, including LV end-diastolic volume index [mean, -5.1 mL/m2; 95% confidence interval (CI), -10.2 to -0.04; P = 0.048] and tricuspid regurgitation peak velocity (mean, -0.17 m/s; 95% CI, -0.31 to -0.03; P = 0.016). In a subgroup analysis stratified by LV ejection fraction (LVEF), a reverse remodelling effect was primarily observed in patients with an LVEF < 40%.

Conclusion: Early Sac/Val initiation after hospitalization for AHF may significantly improve LV function and morphology at 8 weeks, particularly in patients with an LVEF < 40%, supporting its role in LV reverse remodelling.