AUTHOR=Monosilio Sara , Filomena Domenico , Luongo Federico , Sannino Michele , Cimino Sara , Neccia Matteo , Mariani Marco Valerio , Birtolo Lucia Ilaria , Benedetti Giulia , Tonti Giovanni , Pedrizzetti Gianni , Vizza Carmine Dario , Maestrini Viviana , Agati Luciano 

TITLE=Cardiac and Vascular Remodeling After 6 Months of Therapy With Sacubitril/Valsartan: Mechanistic Insights From Advanced Echocardiographic Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.883769

DOI=10.3389/fcvm.2022.883769

ISSN=2297-055X

ABSTRACT=Background: Effects of Sacubitril/Valsartan on left ventricular (LV) mechanics and ventricular-arterial coupling in patients with heart failure with reduced ejection fraction (HFrEF) are not completely understood. The aim of this study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients undergoing S/V therapy.
Methods: Fifty HFrEF patients eligible to start therapy with S/V were enrolled. Echocardiographic evaluation was performed at baseline and after six months of follow-up (FU). Besides standard evaluation, including global longitudinal strain (GLS), estimated hemodynamic forces (HDFs) and non-invasive pressure-volume curves (P-V loop) were assessed using dedicated software. HDFs were evaluated over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). Based on estimated P-V loop curves, hemodynamic evaluation included left ventricular end-systolic elastance (Ees), arterial elastance (Ea) and ventricular-arterial coupling (VAC)  
Results: At six months of FU indexed left ventricular end-diastolic and end-systolic volumes decreased (p< 0.001), ejection fraction (p< 0.001) and GLS (p < 0.001) significantly improved. Re-alignment of HDFs occurred, with a reduction of diastolic L-S/A-B HDFs ratio (p< 0.001). A reduction of Ea (p=0.008) and an improvement of Ees (p< 0.001) and VAC (p< 0.001) were observed.
Conclusion: S/V therapy leads to a complex phenomenon of reverse remodeling involving increased myocardial contractility, HDFs distribution improvement, and afterload reduction.