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Recovery of left ventricular dysfunction after sacubitril/valsartan: predictors and management

Hung-Yu Chang1, Kuan-Chun Chen2, Man-Cai Fong3

  • 1Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.

Journal of Cardiology
|September 30, 2019
PubMed

Insights

Sacubitril/valsartan treatment can improve heart failure outcomes, with recovery linked to non-ischemic causes and higher initial drug dosage. Maintaining the sacubitril/valsartan dose is crucial for sustained left ventricular function improvement.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Literature on left ventricular (LV) function recovery post sacubitril/valsartan and optimal heart failure (HF) management is limited.
  • Understanding predictors of LV function recovery and the impact of dosage adjustments is essential for improving patient outcomes.

Purpose of the Study:

  • To investigate factors associated with left ventricular (LV) function recovery in chronic heart failure (HF) patients treated with sacubitril/valsartan.
  • To evaluate the impact of sacubitril/valsartan dosage maintenance versus tapering on LV function and clinical outcomes.

Main Methods:

  • Retrospective analysis of 437 chronic HF patients with LVEF < 40% treated with sacubitril/valsartan.
  • Echocardiographic measurements to assess LVEF recovery and multivariate analysis to identify predictive factors.

Main Results:

  • 17.6% of patients achieved LVEF recovery (≥50%), associated with non-ischemic HF etiology, smaller baseline LV end-diastolic diameter (LVEDD), and higher initial sacubitril/valsartan dosage.
  • LVEF recovery significantly reduced the risk of cardiovascular death or HF hospitalization (HR 0.42, p=0.014).
  • Maintaining sacubitril/valsartan dosage preserved LVEF and reduced CVD/HFH events compared to tapering (5.9% vs 23.1%, HR 0.22, p=0.035).

Conclusions:

  • Non-ischemic HF etiology, smaller baseline LVEDD, and higher initial sacubitril/valsartan dosage predict better LV function recovery.
  • Tapering sacubitril/valsartan in patients with recovered LV function is linked to functional deterioration and poorer prognosis.
Abstract

Keywords:
Heart failureLeft ventricular ejection fractionSacubitril/valsartan

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