Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Abstract

Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (> 35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF > 35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), Díez-Villanueva et al. with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

Beneficial Effect of Left Ventricular Remodeling after Early Change of Sacubitril/Valsartan in Patients with Nonischemic Dilated Cardiomyopathy

“…Patients who were younger than 18 years, those who had combined significant valvular heart disease, or those who had undergone cardiac resynchronization therapy were excluded. Responders to HF medication were defined as patients with an increase in LVEF from ≥10% to a final value of ≥35% according to previous studies [ 10 , 15 ]. The present study was carried out according to the principles of the Declaration of Helsinki and was approved by the Clinical Research Institute of Mediplex Sejong Hospital (approved on 9 June 2020; IRB No.…”

“…Recently, new agents acting on the renin-angiotensin-aldosterone and neutral endopeptidase systems have demonstrated greater improvement in functional class and reduction in cardiac mortality compared with that seen the angiotensin-converting enzyme inhibitor (ACEI), enalapril, in patients with HFrEF [ 6 ]. The subgroup analysis in the PARADIGM-HF study and several other studies have suggested that sacubitril/valsartan improves left ventricular (LV) function and reduces hospitalization and cardiac mortality rates [ 7 , 8 , 9 , 10 , 11 ]. However, most of the subsequent studies on LV function had short follow-up duration or were single-arm studies.…”

A narrative review on sacubitril/valsartan and ventricular arrhythmias

“…Sacubitril/valsartan improves LVEF and significantly reduces emergency treatment rate in patients with HFrEF. [ 24 ] Patients who received a higher initial dose of sacubitril/valsartan tended to have a better recovery of left ventricular function. In patients whose left ventricular function has recovered, a gradual decrease in the dose of sacubitril/valsartan is associated with deterioration of restored cardiac function.…”

Sacubitril-Valsartan, a New Opportunity for Heart Failure with Recovered Ejection Fraction?

“…The study by Díez-Villanueva et al [4] adds to the knowledge base regarding associations between ARNI therapy and cardiac remodeling. This study included 249 outpatients with HF and reduced LVEF who started sacubitril-valsartan between October 2016 and March 2017.…”

“…The results of Díez-Villanueva et al [4] suggest that the reverse myocardial remodeling benefit of sacubitrilvalsartan happens in the early beginning of the treatment. DOI: 10.1159/000506538…”