Left ventricular reverse remodeling following initiation of sacubitril/valsartan for heart failure with reduced ejection fraction and low blood pressure

Sacubitril/valsartan has become an important first-line drug for symptomatic heart failure ( HF) patients, especially with left ventricular (LV) ejection fraction (LVEF) < 50%. However, the impact of sacubitril/valsartan on cardiovascular outcomes, especially LV reverse remodeling for such patients with low blood pressure, remains uncertain. We retrospectively studied 164 HF patients with LVEF < 50% who were treated with sacubitril/valsartan from two institutions. Echocardiography was performed before and 9.5 +/- 5.1 months after initiation of maximum tolerated dose of sacubitril/valsartan. The maximum tolerated dose of sacubitril/valsartan was lower for the low blood pressure group (<= 100 mmHg in systole) than for the nonlow blood pressure group (> 100 mmHg in systole) (165 +/- 106 mg vs. 238 +/- 124 mg, P = 0.017). As expected, significant LV reverse remodeling was observed in the non-low blood pressure group after initiation of sacubitril/ valsartan. It was noteworthy that significant LV reverse remodeling was also observed in the low blood pressure group after initiation of sacubitril/valsartan (LV end-diastolic volume: 177.3 +/- 66.0 mL vs. 137.7 +/- 56.1 mL, P < 0.001, LV end-systolic volume: 131.6 +/- 60.3 mL vs. 94.6 +/- 55.7 mL, P < 0.001, LVEF: 26.8 +/- 10.3% vs. 33.8 +/- 13.6%, P = 0.015). Relative changes in LV volumes and LVEF after initiation of sacubitril/valsartan were similar for the two groups. In conclusion, significant LV reverse remodeling occurred after initiation of sacubitril/valsartan, even in HF patients with LVEF < 50% and systolic blood pressure <= 100 mmHg.