Baseline left ventricular ejection fraction predicts the magnitude of improvement in patients taking...

Sacubitril/valsartan (S/V) improve left ventricular ejection fraction (LVEF) in heart failure patients, but the magnitude of improvement may depend on baseline values.

We analyzed whether baseline LVEF can predict its improvement in patients with LVEF ≤ 45% receiving S/V. Patients were divided into 4 groups (G) according to baseline LVEF (G1: ≤ 20%; G2: 21-30%; G3: 31-40%; G4: 41-45%).

We included 256 patients (age 73 ± 12 years; 73% male; 174 ischemic cardiomyopathy [CM], 82 nonischemic CM) and assessed LVEF at S/V initiation and at 6 and 12 months of therapy. Baseline LVEF (%) values (overall 30.9 ± 8.6) were: G1: 17.3 ± 3.3; G2: 27.5 ± 2.4; G3: 35.5 ± 2; G4: 44.4 ± 1. LVEF increased in 62% of patients, reaching 34.3 ± 10.4% and 35.5 ± 11.2% at 6 and 12 months, respectively (p < 0.001). A significantly higher absolute LVEF increase was found in Groups 3 (7.2 ± 4.3) and 4 (4.2 ± 3.05) than in Groups 1 (0.6 ± 1.5) and 2 (3.5 ± 1.5), in women (5.9 ± 4.4 vs. 4.1 ± 4.5; p < 0.001), with high S/V doses (7.4 ± 4.7 vs. 4.3 ± 4.4; p < 0.001), and in nonischemic CM (6.3 ± 4.9 vs. 3.8 ± 4.2; p < 0.001). On multivariate analysis, female sex (OR 2.18; 95% CI [1.06-4.48]; p = 0.034), high dose (OR 3.38; 95% CI [1.10-10.34]; p = 0.033), and baseline LVEF > 30% (OR 8.62; 95% CI [4.69-15.82]; p = 0.001) were significant predictors of LVEF improvement.

LVEF improvement with S/V depends on baseline values, sex, and dose.