Tapering sacubitril/valsartan doses may worsen LV recovery in HF patients

Higher initial doses of sacubitril/valsartan are associated with better recovery of left ventricular (LV) function in heart failure (HF) patients, a recent study has shown.

The study included 437 consecutive HF patients (mean age, 61.2±14.5 years; 74.6 percent male) who had left ventricular ejection fraction (LVEF) <40 percent at baseline. Participants were treated with sacubitril/valsartan. Recovery of LV function, defined as LVEF recovery to at least 50 percent, was assessed using echocardiography techniques.

At baseline, mean LVEF was 26.9±6.6 percent, while the left atrial diameter was 49.4±8.8 mm. LV end-diastolic (LVEDD) and end-systolic (LVESD) diameters were 59.3±8.8 and 49.0±10.2 mm, respectively. Over the mean follow-up period of 557±136 days, these parameters improved significantly. LVEF, for example, increased by 7.7±11.1 percent.

Seventy-seven patients showed LVEF recovery to at least 50 percent by 12 months. These patients tended to have higher LVEFs at baseline (p=0.004), with smaller LV diameters. Initial doses of sacubitril/valsartan were likewise greater in these patients (106.5±41.4 vs 90.6±40.9 mg; p=0.002).

Those who had LVEF recovery were also significantly more likely to have nonischaemic cardiomyopathies (77.9 percent vs 55.6 percent; p<0.001) and atrial fibrillation (48.1 percent vs 34.7 percent; p=0.028). A history of myocardial infarction, on the other hand, was rarer (14.3 percent vs 32.5 percent; p=0.001).

Moreover, those with recovered LVEF showed significantly better survival outcomes than their nonrecovered counterparts (mortality rate: 11.7 percent vs 24.4 percent; hazard ratio, 0.42, 95 percent confidence interval, 0.21–0.84; p=0.014).