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The first symptoms of cardiac reverse remodeling and clinical improvement after one-month, low-dose of Sacubitril-Valsartan therapy
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  • Wioletta Sacharczuk,
  • Rafał Dankowski,
  • Anna Sowińska,
  • Artur Baszko,
  • Andrzej Szyszka
Wioletta Sacharczuk
Poznan University of Medical Sciences

Corresponding Author:wioletta.sacharczuk@wp.pl

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Rafał Dankowski
Poznan University of Medical Sciences
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Anna Sowińska
Poznan University of Medical Sciences
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Artur Baszko
Poznan University of Medical Sciences
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Andrzej Szyszka
Poznan University of Medical Sciences
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Abstract

Introduction: Little is known about reverse cardiac remodeling (CRR) under the low-dose S/V therapy. Methods: In 37 patients (mean age 64.5±17.5 years, five females) 24/26mg S/V BID was started. After one month of observation, the following CRR parameters improved: LVEDD (-∆2,9±2.6mm, p<0.01), LVESD (-∆ 2,4±2.5mm, p<0.01), LVEDV(-∆14.6±33.1ml, p=0.04), LVESV (-∆13.4±30.6ml, p=0.04), LAVI (-∆8.7±37.7ml/m2, p<0.01), and EROA (-∆ 0.09 ± 0,01cm2; p=0.03). In opposite to LVEF global longitudinal strain (GLS) changed from -6.6% to -7.9% (absolute improvement of 16%, p <0.001). Walked distance in 6-MWT ( +∆65.4 ± 75.8 m, p <0.001), and the quality of life (MLHFQ 22 vs 16 scores, p<0.01) improved. Decreasing NT-proBNP (-∆ 1,203,1±3,121,4pg/ml, p=0.03) and troponin T (-∆ 4.7±9.4pg/ml, p=0.004) were observed. Correlation between GLS and LVESV (r = -0,43, p = 0.027) was found. ROC curve analysis showed that GLS cut-off value -8% is a good predictor of clinical improvement (6MWT: AUC 0.69 p=0.04) and CRR (MRvol: AUC:0.74 p=0.01; LAVI: AUC 0.71 p=0.04). Conclusion: One-month, low-dose (24/26 mg BID) S/V therapy initiates CRR. GLS’s ability to evaluate LV function is better than LVEF’s. S/V should be started early as patients with symptomatic HFrEF and less impaired LV systolic function (GLS <-8%) are more likely to develop CRR and clinical improvement.
23 Mar 2021Submitted to Echocardiography
24 Mar 2021Submission Checks Completed
24 Mar 2021Assigned to Editor
30 Mar 2021Reviewer(s) Assigned
02 May 2021Review(s) Completed, Editorial Evaluation Pending
03 May 2021Editorial Decision: Revise Major
22 May 20211st Revision Received
03 Jun 2021Submission Checks Completed
03 Jun 2021Assigned to Editor
13 Jun 2021Reviewer(s) Assigned
29 Jun 2021Review(s) Completed, Editorial Evaluation Pending