Sacubitril/valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Its effects on left ventricular (LV) remodelling and other echo parameters have not been fully prospectively studied.

The aim of this prospective study was to evaluate if sacubitril/valsartan impacts LV remodelling based on echo parameters and identify the predictive factors of response or intolerance.

From May 2017 to September 2018, 52 HF patients were prospectively enrolled using Paradigm-HF criteria. Echo evaluation was performed before initiating therapy and 3 months after optimal dose adjustment. Patients with absolute improvement in left ventricular ejection fraction (LVEF) ≥5% were considered significant responders.

The 52 patients completing the study but the final population comprised 41 pts, as 11 did not tolerate therapy. Under sacubitril/valsartan, several echo parameters significantly improved: LVEF from 32.6±5 to 36±6% (P<0.0001); LVES volume from 117±40 to 108±46mL (P=0.0051); LVEDD from 60±4 to 57±5mm (P=0.0002). No significant modifications were observed concerning LV diastolic or RV parameters. Sacubitril/valsartan echo responders (n=18/41; 42%) had less severe LV remodelling, indeed LVEDV 144±37vs. 193±47mL (P=0.0009); LVESV 96±28 vs. 133±42mL (P=0.003); LVTDD: 61±4 vs 57±5mm (P=0.02); significant mitral regurgitation 6/18 (33%) vs. 16/23 (69%) (P=0.02); no diastolic LV or RV parameters impacted response. Predictors of intolerance were creatinine level 137±99 vs. 100±24 (P=0.03); LVEF 29±6 vs 33±5% (P=0.04).

In HFrEF patients, sacubitril/valsartan significantly improves LV systolic remodelling. The responders exhibit both less severe LV remodelling and less significant mitral regurgitation. Accordingly, this therapy could be used as soon as possible in order to limit LV remodelling, while precluding non-response or intolerance.