Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 5, October 2019, pages 293-302

Sacubitril/Valsartan Therapy for 14 Months Induces a Marked Improvement of Global Longitudinal Strain in Patients With Chronic Heart Failure: A Retrospective Cohort Study

Figure 1. On the two sides of the figure, there are the LVEF values collected from the group of CHF patients treated with conventional therapy over a mean therapy duration of 14 ± 3 months. Initial mean LVEF value: 38.07 ± 5.44%; final mean LVEF value: 41.59 ± 5.28% (P < 0.0001) (paired samples t-test). LVEF: left ventricular ejection fraction; CHF: chronic heart failure.

Figure 2. On the two sides of the figure, there are the GLS values collected from the group of CHF patients treated with conventional therapy over a mean therapy duration of 14 ± 3 months. Initial mean GLS value: -12.05 ± 4.01%; final mean GLS value: -12.25 ± 4.28% (P = 0.40) (paired samples t-test). GLS: left ventricular ejection fraction; CHF: chronic heart failure.

Figure 3. On the two sides of the figure, there are the LVEF values, recorded before the onset of the therapy with sacubitril/valsartan (left side) and after a mean therapy duration of 14 ± 3 months (right side). Initial mean LVEF value: 39.71 ± 4.78%; final mean LVEF value: 42.11 ± 5.68% (P = 0.0003) (paired samples t-test). LVEF: left ventricular ejection fraction.

Figure 4. On the two sides of the figure, there are the GLS values, recorded before the onset of the therapy with sacubitril/valsartan (left side) and after a mean therapy duration of 14 ± 3 months (right side). Initial mean GLS value: -10.14 ± 3.08%; final mean GLS value: -18.23 ± 7.28% (P < 0.001) (paired samples t-test). GLS: global longitudinal strain.

**Table 1.** Comparison of Demographics and Clinical, Laboratory and Echocardiographic Features of Patients Examined in the Retrospective Study According to Whether or Not a CHF Patient Was Treated With Sacubitril/Valsartan
	Patients treated with sacubitril/valsartan (n = 44)	Patients treated with conventional therapy (without sacubitril/valsartan) (n = 88)	P-value
CHF: chronic heart failure; SD: standard deviation; BMI: body mass index; SBP: systolic blood pressure; CMP: cardiomyopathy; CABG: coronary artery bypass graft; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; ICD: implantable cardioverter defibrillator; NYHA: New York Heart Association; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic diameter.
Baseline demographics
Age (years, mean ± SD)	76 ± 5.5	75 ± 7.5	0.4341
Male sex, n (%)	31 (70.5%)	60 (68.2%)	0.9470
BMI on admission (kg/m², mean ± SD)	28.2 ± 6.87	27.2 ± 5	0.3427
Heart rate at the first visit (beats/min, mean ± SD)	90 ± 19	85 ± 20	0.1711
Heart rate after 6 months (beats/min, mean ± SD)	64 ± 18	80 ± 20	< 0.0001
SBP at the first visit (mm Hg, mean ± SD)	115 ± 26	125 ± 30	0.0617
SBP after 6 months (mm Hg, mean ± SD)	110 ± 21	115 ± 18	0.1574
Comorbidities
Ischemic etiology of HF, n (%)	20 (45.4%)	40 (45.4%)	0.8529
Valvular etiology of HF, n (%)	7 (15.9%)	15 (17%)	0.9342
CMP-induced HF, n (%)	12 (27.2%)	27 (30.6%)	0.8396
Other cause of HF, n (%)	5 (11.3%)	6 (6.8%)	0.5179
Atrial fibrillation, n (%)	22 (50%)	22 (25%)	0.0074
CABG, n (%)	10 (22.7%)	25 (34%)	0.2550
History of hypertension, n (%)	25 (56.8%)	46 (52.2%)	0.7576
DM on insulin, n (%)	10 (22.7%)	25 (28.4%)	0.6255
COPD, n (%)	5 (11.3%)	11 (12.5%)	1.0000
ICD, n (%)	4 (9%)	9 (10.2%)	1.0000
NYHA class IV at baseline, n (%)	1 (2.2%)	6 (6.8%)	0.4234
Hematochemical variables
NT-proBNP at the first visit (pg/mL, mean ± SD)	800.84 ± 123	756.22 ± 129	0.0594
NT-proBNP after 6 months (pg/mL, mean ± SD)	290.5 ± 90.1	591.47 ± 213.81	< 0.0001
Serum creatinine (mL/dL, mean ± SD)	1.46 ± 0.55	1.6 ± 0.4	0.0981
Serum Na⁺ at the first visit (mEq/L, mean ± SD)	136 ± 1.55	137 ± 2.5	0.0166
Serum Na⁺ after 6 months (mEq/L, mean ± SD)	138.5 ± 10	138.4 ± 8.6	0.9526
Serum K⁺ at the first visit (mEq/L, mean ± SD)	4.5 ± 0.6	4.7 ± 0.9	0.1851
Serum K⁺ after 6 months (mEq/L, mean ± SD)	4.8 ± 0.65	4.1 ± 0.85	< 0.0001
Echocardiographic data at the first visit
LVEF (%, mean ± SD)	39.71 ± 4.78	38 ± 5.44	0,0790
LVESD (mm, mean ± SD)	58 ± 10	59 ± 14	0.6733
E/A ratio (mean ± SD)	3 ± 1.25	3.4 ± 1.35	0.1026
Deceleration time (ms, mean ± SD)	136 ± 22	145 ± 25	0.0362

Table 1. Comparison of Demographics and Clinical, Laboratory and Echocardiographic Features of Patients Examined in the Retrospective Study According to Whether or Not a CHF Patient Was Treated With Sacubitril/Valsartan

Patients treated with sacubitril/valsartan (n = 44)

Patients treated with conventional therapy (without sacubitril/valsartan) (n = 88)

P-value

CHF: chronic heart failure; SD: standard deviation; BMI: body mass index; SBP: systolic blood pressure; CMP: cardiomyopathy; CABG: coronary artery bypass graft; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; ICD: implantable cardioverter defibrillator; NYHA: New York Heart Association; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic diameter.

Baseline demographics

Age (years, mean ± SD)

76 ± 5.5

75 ± 7.5

0.4341

Male sex, n (%)

31 (70.5%)

60 (68.2%)

0.9470

BMI on admission (kg/m², mean ± SD)

28.2 ± 6.87

27.2 ± 5

0.3427

Heart rate at the first visit (beats/min, mean ± SD)

90 ± 19

85 ± 20

0.1711

Heart rate after 6 months (beats/min, mean ± SD)

64 ± 18

80 ± 20

< 0.0001

SBP at the first visit (mm Hg, mean ± SD)

115 ± 26

125 ± 30

0.0617

SBP after 6 months (mm Hg, mean ± SD)

110 ± 21

115 ± 18

0.1574

Comorbidities

Ischemic etiology of HF, n (%)

20 (45.4%)

40 (45.4%)

0.8529

Valvular etiology of HF, n (%)

7 (15.9%)

15 (17%)

0.9342

CMP-induced HF, n (%)

12 (27.2%)

27 (30.6%)

0.8396

Other cause of HF, n (%)

5 (11.3%)

6 (6.8%)

0.5179

Atrial fibrillation, n (%)

22 (50%)

22 (25%)

0.0074

CABG, n (%)

10 (22.7%)

25 (34%)

0.2550

History of hypertension, n (%)

25 (56.8%)

46 (52.2%)

0.7576

DM on insulin, n (%)

10 (22.7%)

25 (28.4%)

0.6255

COPD, n (%)

5 (11.3%)

11 (12.5%)

1.0000

ICD, n (%)

4 (9%)

9 (10.2%)

1.0000

NYHA class IV at baseline, n (%)

1 (2.2%)

6 (6.8%)

0.4234

Hematochemical variables

NT-proBNP at the first visit (pg/mL, mean ± SD)

800.84 ± 123

756.22 ± 129

0.0594

NT-proBNP after 6 months (pg/mL, mean ± SD)

290.5 ± 90.1

591.47 ± 213.81

< 0.0001

Serum creatinine (mL/dL, mean ± SD)

1.46 ± 0.55

1.6 ± 0.4

0.0981

Serum Na⁺ at the first visit (mEq/L, mean ± SD)

136 ± 1.55

137 ± 2.5

0.0166

Serum Na⁺ after 6 months (mEq/L, mean ± SD)

138.5 ± 10

138.4 ± 8.6

0.9526

Serum K⁺ at the first visit (mEq/L, mean ± SD)

4.5 ± 0.6

4.7 ± 0.9

0.1851

Serum K⁺ after 6 months (mEq/L, mean ± SD)

4.8 ± 0.65

4.1 ± 0.85

< 0.0001

Echocardiographic data at the first visit

LVEF (%, mean ± SD)

39.71 ± 4.78

38 ± 5.44

0,0790

LVESD (mm, mean ± SD)

58 ± 10

59 ± 14

0.6733

E/A ratio (mean ± SD)

3 ± 1.25

3.4 ± 1.35

0.1026

Deceleration time (ms, mean ± SD)

136 ± 22

145 ± 25

0.0362