Heart failure and reduced ejection fraction (HF rEF) has a poor prognosis, even worse when diastolic dysfunction progresses from grade 1 to the unfavorable grade 3.

The purpose of our work was to evaluate the reversibility of diastolic dysfunction before and after sacubitril/valsartan administration in patients with HF REF.

A total of 43 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. To classify diastolic dysfunction according to the ASE/EACVI guidelines published in 2016, transmitral E and A waves velocities, septal and lateral E’ tissue velocities, indexed left atrium volume and peak velocity of tricuspid regurgitation were collected. From multiparametric approach, Patients were subsequently categorized as diastolic dysfunction grade 1, 2 or 3. Patients with atrial fibrillation or missing data have been classified as undetermined.

Mean age was 58.9±14.9 yo and 72.7% patients were males. Ejection fraction averaged 30.5±7.2 Overall, after 6.1±3.6 months of treatment with sacubitril/valsartan, E/A ratio decreased from 1.9±1.5 to 1.04±0.72 (P<0.05), the E/Ea ratio decreased from 14.8±6.5 vs. 10.5±5.2 (P<0.05), tricuspid regurgitation peak velocity decreased from 3.0±0.7 to 2.5±0.5m/s (P=0.03) and left atrial volume decreased from 53.3±29.7 to 40.6±13.7ml/m² (P <0.05). Subsequently, both left-ventricular diastolic function and filling pressure improved significantly (P<0.05, Fig. 1).

In patients with heart failure and reduced ejection fraction, administration of sacubitril/valsartan was associated with improvement of diastolic dysfunction and filling pressure.