Effects of Sacubitril/Valsartan treatment on left ventricular myocardial
torsion mechanics in heart failure reduced ejection fraction patients,2D
speckle tracking imaging.
Background: Left ventricular ejection fraction (LVEF) is calculated from
volumetric change without representing true myocardial properties.
Strain echocardiography has been used to objectively measure myocardial
deformation. Myocardial strain can give accurate information about
intrinsic myocardial function, and it can be used to detect early-stage
cardiovascular diseases, monitor myocardial changes with specific
therapies, differentiate cardiomyopathies, and predict the prognosis of
several cardiovascular diseases. Sacubitril/Valsartan has been shown to
improve mortality and reduce hospitalizations in patients with heart
failure with reduced ejection fraction (HFrEF). The effect of
Sacubitril/Valsartan on LV ejection fraction (EF) and torsion dynamics
in HFrEF patients have not been previously described. Results: ARNI
group of patients showed improvement of symptoms, LVGLS% and diastolic
parameters including, E/A, E/e’, TV, untwist onset and rate after 6
months of therapy in comparison to the traditionally treated patients.
The improvement continued for 11 months with in additional significant
improvement of systolic parameters in the form of LVGLS%, EF%, Twist,
Apical and basal rotations, main dependent parameters for improvement of
EF% was LVGLS% and Apical rotation. Conclusion: To our knowledge this
is the first study to demonstrate that therapy with Sacubitril/Valsartan
in HFrEF patients could create a state of gradual and chronic LV
deloading which cause relieving of myocardial wall tensions and
decreasing the LV end diastolic pressure this state could cause cardiac
reverse remodeling and reestablishment of starling forces proprieties of
LV myocardium, which lead to increase of LV ejection fraction.