Clinical Characteristics Of Heart Failure Patients With Recoverable Ejection Fraction After The Treatment Of Sacubitril/valsartan

Objective:To observe the clinical characteristics of chronic heart failure patients with recoverable ejection fraction after the treatment of Sacubitril/Valsartan.Methods:From December 2017 to April 2020,patients with chronic heart failure which received the treatment of Sacubitril/Valsartan were enrolled.The inclusive criteria was that left ventricular ejection fraction(LVEF)<40%.All patients were followed up until December 2020 or until the all-cause death or heart transplantation.The epidemiological data,laboratory examination,echocardiographic indexes and drug use were collected.According to the results of echocardiography,the recovery of ejection fraction was defined as meeting two criteria at the same time:(1)LVEF increased by more than 10%compared with the baseline level;(2)any follow-up LVEF>40%.According to the recovery of LVEF,the patients were divided into the LVEF recoverable group and the LVEF unrecoverable group.The differences of clinical data between the two groups were compared,and influencing factors for recovery of LVEF were analysed by Logistic regression analysis.The all-cause death,heart transplantation or rehospitalization of heart failure were defined as adverse events.Survival analysis was conducted by Kaplan-Meier method to compare the prognosis between two groups by Log-rank test.Results:A total of 131 patients with heart failure with reduced ejection fraction(HFr EF)met the inclusion criteria,but only 75 patients were enrolled in this research by excluding 8 cases of drug withdrawal,40 cases of lack of reexamination and 8 cases of loss of follow-up.During the median follow-up of 21 months(3～36 months),the LVEF of the two groups was improved in different degrees after treatment(P<0.001).In the LVEF recoverable group,25 cases(33.3%)had an increase of(21.6±7.8)%,while 50cases(66.7%)just had an increase of(3.2±4.7)%in the LVEF unrecoverable group.There was significant difference in LVEF improvement between the two groups(P<0.001).And there were statistically significant differences in the course of heart failure,systolic blood pressure≥120mm Hg,diastolic blood pressure,glomerular filtration rate,N-terminal probrain B type natriuretic peptide(NT-pro BNP),baseline LVEF and left ventricular end diastolic diameter(LVEDD)between the two groups(P<0.05).Logistic regression analysis showed that the duration of heart failure≤6 months(OR=4.730,95%CI 1.069-20.919,P=0.041),higher glomerular filtration rate(per 10ml/min/1.73m~2elevation,OR=1.511,95%CI 1.107-2.062,P=0.009),greater decrease of N-terminal pro brain B type natriuretic peptide(NT-pro BNP)(per 10%decrease,OR=1.699,95%CI1.240-2.329,P=0.001)and higher baseline LVEF(per 5%increase,OR=2.731,95%CI1.365-5.465,P=0.005)were the influencing factors for LVEF recovery.The rate of adverse events(all-cause death,heart transplantation or rehospitalization of heart failure)in the LVEF recoverable group was lower than that in the LVEF unrecoverable group(24.0%vs 62.0%,P=0.002).Kaplan-Meier survival analysis showed that the event-free survival rate in the LVEF recoverable group was significantly higher than that in the LVEF unrecoverable group(P=0.008).Conclusion:The treatment of Sacubitril/Valsartan could improve LVEF.The patients with short duration of heart failure≤6 months,better renal function,greater decrease of NT-pro BNP after treatment and higher baseline level of LVEF had greater possibilities of LVEF recovery and better prognosis.