Do the remodeling effects of sacubitril/valsartan treatment depend upon heart failure duration?

<p>Aims The angiotensin receptor and neprilysin inhibitor&nbsp;(ARNI) sacubitril/valsartan (LCZ696) is&nbsp; recommended for the treatment of patients with heart failure in New York Heart Association (NYHA) class II&ndash;III and left ventricular ejection fraction (LVEF) 35% or less. We examined the effects of sacubitril/valsartan on cardiac remodeling and their correlation with heart failure duration in patients enrolled in&nbsp;our heart failure clinic from March 2017 to December 2019.&nbsp;<br> Methods Echocardiographic and clinical/laboratory data&nbsp;were collected at baseline and at 6-month and 12-month&nbsp;follow-up visits in 69 patients (age 67+/-12 years, disease&nbsp;duration 8.4W5.8 years, 93% men).<br> Results At both time points, mean NYHA class, NT-proBNP&nbsp;level, LVEF, LV end-systolic volume, and estimated systolic&nbsp;pulmonary pressure significantly (P&lt;0.05) improved versus&nbsp;baseline, as did the proportion of patients with diastolic&nbsp;dysfunction grade 3 or functional mitral regurgitation grade&nbsp;3&ndash;4. In the subgroup with mean disease duration less than&nbsp;8.5 years (n = 40), there was a significant improvement in all&nbsp;variables at both time points; in this group, a recovery of&nbsp;right ventricular function was also seen at the 12-month&nbsp;follow-up. On the contrary, patients with heart failure&nbsp;duration of at least 8.5 years (n=29) showed only a slight&nbsp;improvement in LVEF and mitral regurgitation at 12 months.&nbsp;There were no significant changes in renal function and/or&nbsp;potassium levels in all patients.&nbsp;<br> Conclusion In patients with a relatively short disease&nbsp;duration, sacubitril/valsartan was associated with a strong&nbsp;favorable remodeling of the left ventricle and improvement&nbsp;in pulmonary circulation.</p>