Mohammed Alnims, Magdy Abdelhamid1, Mohamed Abdel Meguid1, Ahmed Shehata1

1Cairo University, Cairo, Egypt

Background:
Heart failure (HF) is a heavy medical and societal burden. The prevalence of HF is ~1–2% of the adult population in developed countries, rising to ≥10% among people > 70 years of age. Angiotensin receptor–neprilysin inhibition with Sacubitril/Valsartan was superior to Angiotensin converting enzyme inhibition alone in reducing the risks of death and of hospitalization for heart failure.

Objectives: To evaluate the clinical and echocardiographic outcome of Sacubitril/Valsartan therapy in patients with ischemic and dilated cardiomyopathy.

Method(s):
We performed a single center, prospective, cohort study of HFrEF patients (n=100) who were treated with Sacubitril/Valsartan for a median duration of 6 months. Clinical and echocardiographic parameters were reviewed at baseline and after 6 months.

Result(s):
Among 100 patients (n=56 with ischemic cardiomyopathy (ICM) and n=44 with dilated cardiomyopathy (DCM)), ICM patients were older and having more risk factors as diabetes, hypertension, smoking and peripheral vascular disease. Among patients with DCM, the median LVEF was 32% and increased to 38% after treatment (P < 0.001), and the median LVEF in patients with ICM was 30% and increased to 34% after treatment (P < 0.001). Left ventricular diastolic volume in patients with DCM decreased from a median baseline 184 to 142ml (P <0.001) and in patients with ICM decreased from a median baseline 174 to 158ml (P <0.001). Left ventricular systolic volume in patients with DCM decreased from a median baseline 130 to 83ml (P <0.001) and in patients with ICM decreased from a median baseline 123 to 107ml (P .002). There was also statistically significant change in quality of life of both groups using Minnesota Living with Heart Failure Questionnaire score (MLHFQ) but more favorable change in patients with DCM (55, 27 before and after treatment, P <0.001) when compared to patients with ICM (59, 38 before and after treatment, P <0.001).

Conclusion(s):
Sacubitril/Valsartan had shown statistically significant improvement clinically and in echocardiographic parameters in both groups with DCM and ICM, the magnitude of changes were numerically better in patients with dilated cardiomyopathy, however these differences were not reaching statistically significance.