Sacubitril/valsartan in the treatment of right ventricular dysfunction in patients with heart failure with reduced ejection fraction: a real-world study.

Objective There is increasing evidence supporting the efficacy of sacubitril/valsartan for treating left heart failure, but few studies have investigated its effects on right ventricular (RV) dysfunction. This study aimed to explore the effects of sacubitril/valsartan on RV dysfunction among patients with heart failure with reduced ejection fraction (HFrEF). Methods A total of 93 HFrEF patients with RV dysfunction who were hospitalized from January 2018 through June 2019 were included in this retrospective observational study. All patients received their first sacubitril/valsartan treatment as inpatients during the study period. We excluded 11 patients who were lost to follow-up or had incomplete heart echocardiography data. After 6 months of follow-up, we reevaluated New York Heart Association (NYHA) functional classification and performed echocardiography to identify changes in relevant variables after treatment. Results At baseline, 24% of the patients had an initial sacubitril/valsartan regimen of 12/13 mg twice daily, and 76% of the patients had an initial dose of 24/26 mg twice daily. During follow-up, 27% of patients increased their dosage to 49/50 mg twice daily, 68% of patients were taking 24/26mg twice daily, and 5% of patents were still taking 12/13mg twice daily. We found that sacubitril/valsartan treatment was associated with significant improvements in the following RV function indicators: tricuspid annular plane systolic excursion (TAPSE), tricuspid annular s' peak velocity (S'), right ventricular fractional area change (RVFAC), and pulmonary artery systolic pressure (PASP). Crude linear regression analysis revealed that a TAPSE improvement was positively correlated with a change in left ventricular ejection fraction (LVEF) and negatively correlated with a change in left ventricular end-systolic volume (LVESV). However, these correlations were nonexistent after adjusting for multiple echocardiographic variables. Conclusions In patients with RV dysfunction and HFrEF, sacubitril/valsartan may improve RV remodeling. This influence may be independent of left cardiac remodeling.