Comparison of the Effect of Sacubitril/Valsartan on Left Ventricular Systolic Function in Patients with Non-ischaemic and Ischaemic Cardiomyopathy

Purpose Sacubitril/valsartan has been demonstrated to improve prognosis and outcomes in heart failure with reduced ejection fraction (HFrEF) patients. We sought to compare the improvement in cardiac function between non-ischaemic and ischaemic cardiomyopathy for patients receiving sacubitril/valsartan. Methods We conducted a single centre prospective cohort survey of patients reviewed in the Heart Function Clinic between February 2017 and January 2018. Functional evaluation and measurement of biochemical and echocardiographic parameters occurred before the initiation of sacubitril/valsartan, and after 3 months of treatment. Results We identified 52 patients (26 non-ischaemic and 26 ischaemic cardiomyopathy) suitable for treatment with sacubitril/valsartan. Treatment was followed by a significant decrease in a New York Heart Association (NYHA) class in both patients with non-ischaemic (2.3 +/- 0.6 vs. 1.6 +/- 0.7,P < 0.001) and ischaemic cardiomyopathy (2.3 +/- 0.5 vs. 1.5 +/- 0.6,P < 0.001), along with an increase in ejection fraction in both patients with non-ischaemic (26.2% +/- 6.5% vs. 37.2% +/- 13.8%,P < 0.001) and ischaemic cardiomyopathy (28.1% +/- 5.7% vs. 31.5% +/- 8.4%,P = 0.007). The improvement in ejection fraction was significantly greater in the patients with non-ischaemic cardiomyopathy compared to those with ischaemic cardiomyopathy (10.7% +/- 13.0% vs. 3.9% +/- 6.0%,P = 0.023). Conclusion Our study suggests that treatment with sacubitril/valsartan in patients with non-ischaemic cardiomyopathy is followed by a greater improvement in ejection fraction than in patients with ischaemic cardiomyopathy.