Sacubitril/Valsartan in Real-World Heart Failure with Reduced Ejection Fraction: Clinical, Echocardiographic, and Tolerability Outcomes — A Study of 300 Patients

Authors

Aouame sara

Journal Information

Journal: Medpeer Publisher

ISSN: 3066-2737

Volume: 3

Issue: 6

Date of Publication: 2026/06/07

DOI: 10.70780/medpeer.000QGTD

Abstract

Abstract
Background: Sacubitril/valsartan (ARNI) demonstrated superior outcomes versus enalapril in the PARADIGM-HF trial, yet real-world data on its comprehensive echocardiographic impact and tolerability in North African patients with high ischemic and comorbidity burden remain scarce.
Methods: We conducted a retrospective, observational, single-center study including 300 patients with HFrEF (LVEF <40%) treated with sacubitril/valsartan after optimized background therapy. Clinical, echocardiographic, and tolerability data were collected at baseline and 12 months. The primary endpoint was quality of life improvement (NYHA class). Secondary endpoints included LVEF change, reverse LV remodeling (indexed LVESV and LVEDV), functional mitral regurgitation (MR) regression, filling pressure normalization (E/E' ratio), and pulmonary artery pressure (PAPs) change.
Results: Mean age was 61.2 ± 5.3 years; 64% male. Ischemic etiology 68%, atrial fibrillation 48%, baseline LVEF 30.7 ± 6.5%. After 12 months, dyspnea prevalence decreased from 95% to 44%; NYHA I increased from 5% to 56%. LVEF improved from 30.7 ± 6.5% to 43.0 ± 7.3% (p<0.001); 61% recovered LVEF >40%. Indexed LVESV decreased from 61.5 ± 12.9 to 35.4 ± 15.9 mL/m² (p<0.001). Severe functional MR regressed from 21% to 10%. PAPs decreased from 48 ± 6 to 25 ± 8 mmHg; E/E' from 10.7 ± 3.2 to 6.3 ± 1.4 (both p<0.001). Target dose (200 mg twice daily) was achieved in 72% of patients; adverse events requiring discontinuation in only 6%.
Conclusions: Sacubitril/valsartan is highly effective and well tolerated in real-world HFrEF, including patients with ischemic etiology, atrial fibrillation, and multiple comorbidities. It induces comprehensive reverse LV remodeling, significant LVEF recovery, functional MR regression, and normalization of filling and pulmonary pressures, confirming its role as a cornerstone of modern HFrEF management.

Keywords

Heart failure with reduced ejection fraction, Sacubitril/valsartan, ARNI, Reverse remodeling, Echocardiography, Quality of life, Real-world, Functional mitral regurgitation