Myocardial remodelling during sacubitril/valsartan therapy in patients with chronic heart failure.

In 30 seconds

This comparative randomized clinical trial assessed cardiac remodelling, clinical symptoms, and metabolic and neurohumoral measures in patients with chronic heart failure in Georgia over 12 months, comparing aliskiren with sacubitril/valsartan. Sacubitril/valsartan was associated with earlier clinical improvement and a rise in left ventricular ejection fraction from 34.2±4.7% to 37.4±4.0% at 6 months and 40.5±3.5% at 12 months (p<0.001). Aliskiren showed later reductions in ventricular volumes and more prominent improvement in valve regurgitation and pulmonary artery pressure. Both groups had improvements in measured metabolic markers.

Key findings

• With sacubitril/valsartan, ejection fraction rose from 34.2±4.7% to 37.4±4.0% at 6 months and 40.5±3.5% at 12 months (p<0.001).
• At 6 months, sacubitril/valsartan was associated with reductions in systolic blood pressure (-6.2%, p<0.001) and NT-proBNP (-10.0%, p<0.05), and increased oxygen saturation (+3.5%, p<0.001).
• With aliskiren, left ventricular end-systolic volume (-15.8%, p=0.009) and end-diastolic volume (-17.6%, p=0.016) decreased significantly at 12 months.
• Both therapies reduced glycated haemoglobin, low-density lipoprotein cholesterol, and triglycerides (p<0.05 for all).

Why it matters

The findings suggest that the two treatment strategies may have different response profiles: sacubitril/valsartan was associated with earlier symptomatic and functional improvement, while aliskiren showed later structural changes. This distinction may help frame clinical assessment of response over time, while the comparative results should be interpreted in the context of the study design and population.

What to keep in mind

The abstract does not report the sample size or provide detailed methods for allocation and outcome assessment, limiting appraisal of the comparative estimates.