ISSN 2996-8215
International Journal of Cardiology | Vol. 15, No. 1, January 2024 | pp. 1–8
DOI: 10.46882/2024/IJC/000177
Original Research Article
Prospective Evaluation of Reverse Mechanical Remodeling Dynamics Following Sacubitril/Valsartan Outpatient Titration
Marcus Thorne¹, Elizabeth Vance¹, Nigel Kirkpatrick²
¹Cardiovascular Research Centre, University of Manchester, Manchester, United Kingdom
²Department of Hypertension, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Abstract:
Angiotensin receptor-neprilysin inhibitors (ARNIs) reduce mortality and heart failure hospitalizations in patients with heart failure and reduced ejection fraction (HFrEF). However, prospective data detailing the precise time course of reverse structural remodeling in stable outpatients remain incomplete. This prospective observational study evaluated the 12-month impact of sacubitril/valsartan on left ventricular volumes, mass, and functional markers. We enrolled 140 stable outpatients with HFrEF (baseline LVEF less than or equal to 35%) who transitioned from standard ACE inhibitors or ARBs to sacubitril/valsartan. Echocardiography was performed at baseline, 6 months, and 12 months post-titration to monitor left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular mass index (LVMI). At 12 months, sacubitril/valsartan therapy was associated with a significant reduction in mean LVESVI (from 74.2 ± 11.4 mL/m² to 58.6 ± 9.2 mL/m², p < 0.001) and LVEDVI (from 112.4 ± 14.8 mL/m² to 94.2 ± 12.1 mL/m², p < 0.001). Concurrently, mean LVEF improved significantly from 28.4% ± 3.4% to 36.5% ± 4.2% (p < 0.001), while LVMI dropped by an average of 18.4 g/m² (p < 0.01). Serum NT-proBNP levels demonstrated a rapid 42% reduction within the first 6 months (p < 0.05). No cases of life-threatening angioedema or severe hyperkalemia occurred. Transitioning to sacubitril/valsartan promotes significant, sustained reverse mechanical remodeling, characterized by marked reductions in left ventricular volumes and mass index alongside robust improvements in systolic performance in stable HFrEF outpatients.
Keywords: Heart failure with reduced ejection fraction, Sacubitril/valsartan, Left ventricular remodeling, Echocardiography, End-systolic volume, Biomarkers
Received: October 08, 2023; Revised: November 20, 2023; Accepted: December 12, 2023; Published: January 18, 2024