Short-term effects of angiotensin receptor-neprilysin inhibitors on diastolic strain and tissue doppler parameters in heart failure patients with reduced ejection fraction: A pilot trial

Objective: Although sacubitril/valsartan has recently shown its long-term benefits on morbidity and mortality in symptomatic patients with chronic heart failure with reduced ejection fraction (HFrEF), its short-term effects on diastolic function remain uncertain. We sought to assess 30-day effects of sacubitril/valsartan on left ventricular (LV) diastolic paremeters determined by speckle tracking and tissue Doppler imaging (STI and TDI respectively) as well as their association with functional capacity change evaluated by peak oxygen uptake (VO(2)max) in stable patients with symptomatic HFrEF. Methods: A total of 35 patients (aged 61 +/- 9 years) eligible for sacubitril/valsartan underwent a complete two-dimension (2D) echocardiographic study and a cardiopulmonary exercise test at baseline and 30 days after the initiation of therapy. Results: Significant improvements in ratio of trans-mitral inflow early diastolic velocity E to mitral annulus early diastolic velocity E' (Delta E//E' = -35.9%, p = 0.001), peak early diastolic strain rate SRE (Delta SRE = +22.5%, p = 0.024) and ratio E/SRE (Delta E/SRE = -33.2%, p = 0.025) were observed after 1-month therapy. Compared with baseline, VO(2)max also increased significantly by 16.7 % (p = 0.001). Baseline E/SRE and Delta E/SRE were the strongest independent predictors of VO(2)max improvement (beta = -0.43, p = 0.004 and beta = 0.45, p = 0.021 respectively) in the multivariate analysis. Conclusion: Sacubitril/valsartan was associated with early improvement in LV diastolic function determined by TDI and 2D STI. Baseline E/SRE was stronger than standard echocardiographic parameters in predicting the early benefit of sacubitril/valsartan therapy. (C) 2019 Hellenic Society of Cardiology. Publishing services by Elsevier B.V.