2.1. Subjects
The study involved 73 patients with HFrEF where they were randomly assigned into two matched groups. Group (1) including 37 patients with traditional treatment of heart failure and the other group (2) including 36 patients were treated with ARNI plus other evidenced based medical treatments. Along the course of the study, 12 patients failed to be followed up. So the final number of cases in the study who succeeded to be followed up to 11 months were group (1) was 27 cases and group (2) was 34 cases, Full history was taken, and full clinical examination was done. Baseline vital signs, ECG, NYHA classification, conventional echocardiography and STE were done at baseline study and after 6 and 9 months.