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Left Atrial Functional Remodeling in Patients with Chronic Heart Failure Treated with Sacubitril/Valsartan

Michele Correale1, Michele Magnesa2, Pietro Mazzeo2

  • 1Cardiology Unit, Cardio-Thoracic Department, Policlinico Riuniti University Hospital, Viale Luigi Pinto 1, 71100 Foggia, Italy.

Journal of Clinical Medicine
|February 11, 2023
PubMed

Insights

Sacubitril/Valsartan therapy improves left atrial (LA) function and structure in heart failure with reduced ejection fraction (HFrEF) patients. Left atrial reverse remodeling is linked to changes in left ventricular volumes and LA strain parameters.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Echocardiography

Background:

  • Previous studies indicate Sacubitril/Valsartan (S/V) therapy promotes left ventricular (LV) and left atrial (LA) reverse remodeling in heart failure with reduced ejection fraction (HFrEF).
  • Predictors of LA structural and functional reverse remodeling (LARR) after S/V therapy, particularly LA strain parameters like peak atrial longitudinal strain (PALS), require further investigation.

Purpose of the Study:

  • To investigate predictors of LA structural and functional reverse remodeling (LARR) in HFrEF patients treated with Sacubitril/Valsartan (S/V).
  • To analyze the impact of S/V therapy on LA strain parameters, including PALS, and their correlation with LARR.

Main Methods:

  • 47 HFrEF patients underwent clinical and echocardiographic evaluation at baseline and after 6 months of S/V therapy.
  • LA structure (LAVi) and function (LAEF, PALS, LA conduit strain, PACS) were measured. Patients were classified as LARR+ (reduction in LAVi > 15%) or LARR-.

Main Results:

  • S/V therapy significantly increased LAEF and reduced LAVi after 6 months; 47% of patients exhibited LARR.
  • LA strain parameters, PALS and LA conduit strain, significantly improved post-therapy.
  • Changes in LV End Diastolic Volume (LVEDV) and PALS were proportional to changes in LAVi.

Conclusions:

  • Six months of S/V treatment improves LA functional reverse remodeling in HFrEF patients in a real-world setting.
  • LARR is associated with changes in LV volumes and LA strain parameters, not baseline echocardiographic variables.
  • S/V therapy establishes a connection between LA and LV reverse remodeling and between LA anatomical and functional remodeling.

Keywords:
ARNIcardiac reverse remodelingchronic heart failure reduced ejection fractionleft atrial functionleft atrial strainsacubitril/valsartan

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