Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic
Giulia Elena Mandoli1, Maria Concetta Pastore1, Alberto Giannoni2,3
1Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, Italy.
Insights
Sacubitril/valsartan treatment improves heart failure outcomes. Echocardiography, specifically global longitudinal strain, predicts left ventricular reverse remodeling and clinical response in heart failure patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Sacubitril/valsartan has transformed heart failure with reduced ejection fraction (HFrEF) treatment, improving morbidity and mortality.
- Left ventricular (LV) reverse remodeling (LVRR) is a key mechanism mediating these benefits.
Purpose of the Study:
- To identify echocardiographic predictors of LVRR in patients with HFrEF treated with sacubitril/valsartan.
- To assess the association between baseline echocardiographic parameters and treatment response.
Main Methods:
- A multicenter study included 341 HFrEF patients treated with sacubitril/valsartan.
- Echocardiographic parameters, including LV global longitudinal strain (GLS) and left atrial strain, were measured at baseline and 6-month follow-up.
- LVRR was defined as LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10%.
Main Results:
- Non-ischaemic aetiology, lower left atrial volume index, and higher baseline GLS were independent predictors of LVRR (P < 0.01).
- A baseline GLS < -9.3% predicted early response (Area Under Curve = 0.75, P < 0.0001).
- Left atrial strain best predicted improvements in NYHA class and NT-proBNP levels.
Conclusions:
- Baseline speckle tracking echocardiography parameters can predict LVRR and clinical response to sacubitril/valsartan.
- These echocardiographic measures may guide treatment decisions in HFrEF patients.
Aims:
Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods And Results:
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10% at follow-up] at 6 month follow-up as the primary endpoint. Changes in symptoms [New York Heart Association (NYHA) class] and neurohormonal activations [N-terminal pro-brain natriuretic peptide (NT-proBNP)] were also evaluated as secondary endpoints; 341 patients (excluding patients with poor acoustic windows and missing data) were analysed (mean age: 65 ± 10 years; 18% female, median LVEF 30% [inter-quartile range: 25-34]). At 6 month follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥ 35%), 55 (16%) early incomplete response (LVRR and LVEF < 35%), and 204 (60%) no response (no LVRR and LVEF < 35%). Non-ischaemic aetiology, a lower left atrial volume index, and a higher GLS were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). A baseline GLS < -9.3% was significantly associated with early response (area under the curve 0.75, P < 0.0001). Left atrial strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05).
Conclusions:
Speckle tracking echocardiography parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan and could be used as a guide for treatment in patients with HFrEF.
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