Assessment of Left Ventricular Myocardial Torsion Mechanics in Patients with Heart Failure with Reduced versus Preserved Ejection Fraction Receiving Sacubitril/Valsartan

Background: Heart failure (HF) with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) exhibit distinct myocardial dynamics, which can potentially be modified by therapeutic interventions. This study aims to evalu ate the effects of sacubitril/valsartan on left ventricular myocardi al torsion mechanics in patients with HFrEF versus HFpEF. Methods: In this prospective, randomized controlled study, 105 patients with HF, classified based on ejection fraction (EF) into HFrEF (EF < 40%) and HFpEF (EF ≥ 50%), were recruited from the International Medical Centre hospital in Jeddah and Banha University Hospital. Patients were divided into three groups: Group I (n=35, HFrEF, sacubitril/valsartan + standard therapy), Group II (n=35, HFpEF, sacubitril/valsartan + standard therapy), and Group III (n=35, HFrEF, standard therapy only). Participants underwent comprehensive echocardiographic evaluations using speckle tracking imaging to assess myocar dial torsion mechanics. Results: After six months, LVEF increased significantly in Group II (54.7 ± 2.9% to 56.9 ± 4.5%, P<0.001) compared to Groups I (32.8 ± 4.4% to 35.3 ± 3.9%) and III (30.8 ± 5.6% to 31.1 ± 6%). Group I showed significant improvement in NYHA classification post-treatment compared to Groups II and III, with 62.9% of patients improving to Class II (P=0.044). Left ventricular global longitudinal strain (LVGLS) improved significantly in Groups I and II (P=0.001 for both) compared to Group III, demonstrating better myocardial function recovery. Conclusion: Sacubitril/valsartan significantly improves myo cardial torsion mechanics in HFpEF patients compared to HFrEF patients, suggesting differential myocardial responses to the drug based on the underlying myocardial structure and func tion in HF subtypes.