Cardiac and vascular remodeling after 6 months of therapy with sacubitril/valsartan. mechanistic insights from advanced echocardiographic analysis

Sacubitril/Valsartan (S/V) was proven to significantly modify the clinical course of patients with heart failure with reduced ejection fraction (HFrEF), improving symptoms, outcomes and functional capacity as a consequence of cardiac reverse remodeling (RR) (1–7). Studies on S/V induced RR focused on volumetric changes and improvement of cardiac function in terms of ejection fraction. This approach fails to describe the complex effects of S/V on cardiovascular (CV) physiopathology. Data on intraventricular pressure gradients (IVPGs) distribution are missing and those on vascular properties changes are frequently limited to hypertensive cohorts. The aim of our study was to evaluate both cardiac and vascular remodeling in a group of HFrEF patients after 6 months of therapy with S/V, in terms of volumes, contractility, IVPGs distribution, vascular properties and ventricular-arterial coupling.