Background:
Left ventricular ejection fraction (LVEF) is calculated from volumetric
change without representing true myocardial properties. Strain
echocardiography has been used to objectively measure myocardial
deformation. Myocardial strain can give accurate information about
intrinsic myocardial function, and it can be used to detect early-stage
cardiovascular diseases, monitor myocardial changes with specific
therapies, differentiate cardiomyopathies, and predict the prognosis of
several cardiovascular diseases. Sacubitril/Valsartan has been shown to
improve mortality and reduce hospitalizations in patients with heart
failure with reduced ejection fraction (HFrEF). The effect of
Sacubitril/Valsartan on LV ejection fraction (EF) and torsion dynamics
in HFrEF patients have not been previously described.
Results: ARNI group of patients showed improvement of symptoms,
LVGLS% and diastolic parameters including, E/A, E/e’, TV, untwist onset
and rate after 6 months of therapy in comparison to the traditionally
treated patients. The improvement continued for 11 months with in
additional significant improvement of systolic parameters in the form of
LVGLS%, EF%, Twist, Apical and basal rotations, main dependent
parameters for improvement of EF% was LVGLS% and Apical rotation.
Conclusion: To our knowledge this is the first study to
demonstrate that therapy with Sacubitril/Valsartan in HFrEF patients
could create a state of gradual and chronic LV deloading which cause
relieving of myocardial wall tensions and decreasing the LV end
diastolic pressure this state could cause cardiac reverse remodeling and
reestablishment of starling forces proprieties of LV myocardium, which
lead to increase of LV ejection fraction.