Abstract:

Objective: To evaluate the effects of Sacubitril/Valsartan on clinical and echocardiographic parameters in patients with heart failure with reduced ejection fraction who were previously being treated with ACE inhibitors. Study Design: Prospective cross-sectional study. Place and Duration of Study: Combined Military Hospital Bahawalpur, from Sep 2020 to Mar 2021. Methodology: A hundred patients with heart failure with reduced ejection fraction (HFrEF) previously treated with ACE inhibitors for at least 24 weeks were enrolled for the study. Fifty patients were then switched from treatment with ACE inhibitors to sacubitril/valsartan and defined as the A to S/V group and treated to observe changes in NYHA class and left ventricular ejection fraction up to 6 months. In the same period, the rest of the 50 patients were continued with ACE inhibitor treatment defined as the A to A group, the dose of ACE Inhibitor was maintained at the same level. NYHA class and echo-cardiography was performed in outdoor clinics at enrolment (baseline) and after 6 months of Sacubitril/Valsartan treatment. NYHA class and echocardiographic parameter were recorded and analyzed after 6 months. Results: There was no statistically significant difference in the age, gender, HR, Systolic BP, Diastolic BP, NYHA class and LVEF between the two groups at enrollment. In A to A group there was no significant change in LVEF and NYHA class after 6 month of observation and continued treatment with ACE inhibitors. A significant improvement was found in the baseline LVEF (%) (30.2 ± 2.62) to (32 ± 2.43) p-value (<0.001) in A to S/V group. At the end of the study, LVEF showed improvement in echocardiography in patients treated with sacubitril/valsartan compared to ACE Inhibitor treatment. Clinical improvement was observed in 16 (32%) patients who moved to NYHA class-II from NYHA class-III. Conclusion: Sacubitril/Valsartan in comparison to ACE Inhibitor treatment had a statistically significant clinical improvement in NYHA class II/III and LVEF on echocardiography at 6 months.

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