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Improved heart function with sacubitril/valsartan was linked to enhanced ventricular-arterial coupling and cardiac efficiency in individuals with reduced ejection fraction.

A study published in June 2025 issue of American Journal of Cardiology described left ventricular (LV) reverse remodeling (RR) as a known response to therapies that alleviate neurohormonal activation and hemodynamic overload in individuals with heart failure with reduced ejection fraction (HFrEF).  

Researchers conducted a retrospective study to analyze whether LVRR with sacubitril/valsartan (S/V) treatment was associated with changes in VA coupling and alterations in mechanoenergetic parameters.  

They analyzed data from 662 individuals with  HFrEF and LV ejection fraction (LVEF) ≤40% who received S/V therapy across multiple centers. The mean age was 65±11 years. Non-invasive pressure-volume (PV) loops were derived using echocardiography and brachial artery blood pressure. Arterial elastance (Ea), LV elastance (Ees), and the Ea/Ees ratio were calculated. Mechanoenergetic parameters, including stroke work, potential energy (PE), PV area (PVA), and LV efficiency, were also estimated.  

The results showed that at a median follow-up of 7.8 months, 14% of individuals demonstrated LVRR, defined as a LVEF increase >10% and a relative reduction in LV end-systolic volume >15%. In this subgroup, VA coupling improved from 2.90 ± 1.33 to 1.58 ± 0.53 (−45%) and LV efficiency rose from 46% to 57% (+24%). The PE declined from 0.68 ± 0.18 joule to 0.44 ± 1.0 joule (−35%). VA coupling showed strong inverse correlations with LV efficiency at baseline (r = −0.92) and at follow-up (r = −0.74).  

Investigators concluded that individuals with LVRR and treated with S/V were linked to improved VA coupling, which likely contributed to enhanced LV efficiency as reflected by the SW to PVA ratio.  

Source: ajconline.org/article/S0002-9149(25)00372-8/abstract