Related Experiment Video

Updated: Jul 12, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

10.5K

Reverse Remodeling Effects of Sacubitril-Valsartan: Structural and Functional Optimization in Stage C Heart Failure

Sara Kalanatari1, Daniel Oren2, Diego Medvedofsky3

  • 1Section of Cardiology, University of Chicago Medicine, Chicago, Illinois.

The American Journal of Cardiology
|October 26, 2023
PubMed

Insights

Sacubitril-valsartan significantly improves ventricular remodeling in heart failure patients. This angiotensin receptor-neprilysin inhibitor therapy reduces left and right ventricular volumes and enhances left ventricular ejection fraction.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Imaging

Background:

  • Sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, is established to reduce mortality and hospitalizations in heart failure with reduced ejection fraction (HFrEF).
  • Optimizing guideline-directed medical therapy (GDMT) is crucial for HFrEF management, but ventricular remodeling effects of sacubitril-valsartan initiation in such patients require further elucidation.

Purpose of the Study:

  • To investigate the impact of initiating sacubitril-valsartan on ventricular remodeling in HFrEF patients already optimized on GDMT.
  • To assess changes in left ventricular (LV) and right ventricular (RV) volumes, LV function, and RV size and function using 3-dimensional echocardiography.

Main Methods:

  • A prospective, single-arm longitudinal study involving 40 HFrEF patients on optimized GDMT.
  • Patients were transitioned to sacubitril-valsartan, with primary endpoint being change in LV volume at 1 year via 3D transthoracic echocardiography.
  • Secondary endpoints included changes in LV ejection fraction, RV size, and RV function.

Main Results:

  • At 1 year, significant reductions in LV end-diastolic volume (242 to 157 ml, p<0.001) and increases in LV ejection fraction (32% to 44%, p<0.001) were observed.
  • Significant decrease in RV end-diastolic volume (151 to 105 ml, p<0.001) was noted.
  • While RV ejection fraction remained unchanged, RV global longitudinal strain showed significant improvement (from -14.9% to -19.3%, p<0.001).

Conclusions:

  • Sacubitril-valsartan, when added to standard HFrEF therapy, induces significant beneficial remodeling in both the left and right ventricles.
  • These findings, assessed by 3D echocardiography, highlight the drug's role in reversing adverse ventricular changes in HFrEF.
  • The study supports sacubitril-valsartan's efficacy in improving cardiac structure and function beyond GDMT alone.

Keywords:
ARNIrecoveryreverse remodelingsacubitril-valsartan

More Related Videos

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents07:26

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

Published on: July 14, 2021

5.1K
A Rat Model of Pressure Overload Induced Moderate Remodeling and Systolic Dysfunction as Opposed to Overt Systolic Heart Failure07:13

A Rat Model of Pressure Overload Induced Moderate Remodeling and Systolic Dysfunction as Opposed to Overt Systolic Heart Failure

Published on: April 30, 2020

6.5K

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
438
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
9
Heart Failure Drugs: &#946;-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
346
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
400
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
14
Structure-Activity Relationships and Drug Design01:28

Structure-Activity Relationships and Drug Design

Drug design is a dynamic field that involves discovering and developing new medications based on specific biological targets. This process heavily relies on structure-activity relationships (SAR) and quantitative structure-activity relationships (QSAR) to guide the design and optimization of efficient drugs.
SAR studies the intricate relationship between a drug's chemical structure and biological activity. It focuses on understanding how modifications to a drug's structure can influence...
735