Improved heart function and cardiac remodelling following sacubitril/valsartan in acute coronary syndrome with HF

Aims This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI).Methods and results We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6 months after treatment when a clinical follow-up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non-ST-elevation myocardial infarction (NSTEMI) group, and ST-elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT-proBNP in both groups and evaluated the correlation between the changes in the above variables (Delta LVEF, Delta LVMI, Delta LVEDVI, Delta LVESVI, and Delta NT-proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P < 0.05), NT-proBNP, LVMI, and LVESVI decreased significantly in both groups after 6 months (P < 0.05), and LVEDVI decreased significantly in the S/V group (P = 0.001). In the S/V group, Delta LVEF (t = -2.745, P = 0.006), Delta NT-proBNP (P = 0.009), Delta LVEDVI (t = 4.203, P = 0.001), and Delta LVESVI (t = 3.907, P = 0.001) were significantly improved than those in the routine group. In the S/V group, Delta LVEF was negatively correlated with Delta NT-proBNP (r = -0.244, P = 0.004), Delta LVMI (r = -0.190, P = 0.028), Delta LVEDVI (r = -0.173, P = 0.045), and Delta LVESVI (r = -0.261, P = 0.002). In Cox regression model analysis, Delta LVEF {hazard ratio [HR] = 0.87 [95% confidence interval (CI) 0.80-0.95], P = 0.003}, Delta LVEDVI [HR = 1.04 (95% CI 1.01-1.06), P = 0.013], and Delta LVESVI [HR = 1.04 (95% CI 1.01-1.08), P = 0.026] were independent risk factors for MACE. Subgroup analysis showed that Delta LVEF (t = 6.290, P = 0.001), Delta LVEDVI (t = 2.581, P = 0.011), and Delta NT-proBNP (P = 0.019) in the NSTEMI group were significantly improved than those in the UA group, Delta LVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t = -3.365, P = 0.001), and Delta LVEF in the STEMI group was significantly better than that in the UA group (t = -3.928, P = 0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan-Meier curve (P = 0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P = 0.004).Conclusions The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT-proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first-line heart failure treatment after PCI.