Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background: The discovery and introduction of Neprilysin inhibitor in treating chronic heart failure (New York heart association class II{u2013}IV) with reduced ejection fraction (HFrEF) is a remarkable landmark in therapy. The clinical outcome of reducing the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure was demonstrated in PARADIGM-HF trial. These benefits may be related to effects on hemodynamics and cardiac remodeling. Objectives: To evaluate the clinical and echocardiographic outcome of Sacubitril/Valsartan therapy in HFrEF patients, in addition to its efficacy in reducing mortality and rehospitalisation rate. Methods: We performed a single center, prospective, cohort study of HFrEF patients (n=100) who were treated with Sacubitril/Valsartan for a median duration of 6 months. Clinical and echocardiographic parameters were reviewed at baseline and after 6 months. Results: Among 100 patients (median age, 56.5 years; 76% men), at 6 months, improvement of NYHA class has occurred in 83.9% patients (P < 0.001) and only 16.1% remain unchanged. The median LVEF was 30% and increased to 35% after treatment (P < 0.001), about 51.6% patients showed increase in LVEF at least by 5% and 23.7% showed increase in LVEF at least by 10%. Left ventricular diastolic volume decreased from a median baseline 179 to 150ml (P < 0.001), and left ventricular systolic volume decreased from a median baseline 125 to 91ml (P <0.001). About 84 (84%) patients were hospitalized before starting the treatment, and only 33 (35.9%) patients were rehospitalized after initiating the treatment during the follow up period (P=.007).The most frequent adverse events were hypotension (7.5%), hyperkalemia (7.5%), and worsening kidney function 6.5%

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