Insights into the Benefits of Reverse Remodeling from an Echocardiographic Pressure/Volume Loop Model in Patients With Heart Failure Treated With Sacubitril/Valsartan.

Left ventricular (LV) reverse remodeling (RR) can occur in response to interventions that reduce the neurohormonal activation and hemodynamic overload in patients with heart failure with reduced ejection fraction (HFrEF). Aim of the study was to investigate whether the occurrence of LVRR in response to treatment with sacubitril/valsartan (S/V) is related to changes of ventricular-arterial (VA) coupling, as defined by the ratio of arterial elastance (Ea)/LV elastance (Ees), as well as to modifications of mechanoenergetic parameters. The study included 662 patients with HFrEF and LV EF ≤40% who underwent S/V therapy. The mean age of the study population was 65±11 years. Non-invasive pressure-volume (PV) loops were obtained from echocardiography with brachial artery blood pressure measurements. Ea, Ees and the ratio Ea/Ees and mechanoenergetic parameters, including stroke work (SW), potential energy (PE), PV area (PVA) and LV efficiency, were estimated. At 6-month follow-up, 14% of patients exhibited LVRR, defined as >15% reduction of LV end-diastolic volume and >10 units % increase of LVEF. In these patients, VA coupling changed from 2.90 ± 1.33 to 1.58 ± 0,53 (-45%) and LV efficiency increased from 46% to 57% (+24%), while PE decreased from 0.68 ± 0.18 joule to 0.44 ±1.0 joule (-35%). VA coupling was closely associated with LV efficiency at baseline (r = - 0.92) and at follow-up (r = - 0.74). In this study, LVRR occurred in patients treated with S/V and was associated with a better VA coupling that likely accounted for the beneficial effects on LV efficiency, namely SW/PVA.