Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Abstract

<b><i>Background:</i></b> A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. <b><i>Methods:</i></b> We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). <b><i>Results:</i></b> After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, <i>p</i> = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, <i>p</i> = 0.096) and higher blood pressure before and after SV (both, <i>p</i> < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, <i>p</i> = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, <i>p</i> = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, <i>p</i> < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13–0.47, <i>p</i> < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, <i>p</i> < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, <i>p</i> < 0.0001). Functional class improved in both groups, mainly in group R (<i>p</i> = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, <i>p</i> = 0.07). <b><i>Conclusions:</i></b> In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.