Patients with heart failure and reduced ejection fraction (HF rEF) have a poor prognosis, even worse when diastolic dysfunction progresses.

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

A total of 65 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 61.6±12.6 yo and 78.0% patients were males. Mean ejection fraction was 29.6±7.17%. Overall, after 153.59±115.25 days of treatment with sacubitril/valsartan, E/A ratio decreased from 1.9±1.5 to 1.04±0.72 (P<0.05), as well as E/Ea ratio from 2.04±1.49 to 1.03±0.74 (P<0.01), tricuspid regurgitation peak velocity from 2.95±0.58 to 2.47±0.54m/s (P<0.01) and left atrial volume from 60.42±25.81 to 44.72±20.90ml/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.