The Positive Effect of Sacubitril-valsartan Treatment on Frontal QRS-T Angle in Patients with Heart Failure

Objective: Introducing angiotensin receptor neprilysin inhibitors (ARNI) to daily clinical practice is one of the most important advances in the treatment of heart failure (HF). ARNI is associated with reduced mortality and hospitalization in HF patients due to structural and electrical remodelling. In this study, we investigated the effect of sacubitril/valsartan on the frontal QRS-T angle (f-QRS/Ta), which reflects abnormal ventricular repolarization, in patients with HF with reduced ejection fraction (HFrEF). Method: The difference of f-QRS/Ta obtained from surface electrocardiograms (ECG) in patients with HF and systolic disfunction (EF ≤40%) before and after initiating ARNI treatment was evaluated retrospectively. Demographic, clinic and ECG characteristics of patients collected from hospital data and compared at one year follow-up. Results: A total of 45 patients were enrolled in this study of whom 15 were female (33.3%). The mean NYHA class of the study population was class 2, and the mean left ventricle EF was 30%. ARNI treatment significantly reduced the QRS duration and f-QRS/Ta compared to the baseline ECG parameters. The mean QRS duration decreased from 106.9±10.3 msto 105±9.8 ms at 12 months follow-up, while the baseline f-QRS/Ta of 72.3±12° reduced to 67.4±12.6° after treatment and respectively p-values 0.008 and<0.001 were detected. Conclusion: Our study has shown that in HFrEF patients, sacubitril/valsartan treatment led to a significant decrease in QRS duration and f-QRS/Ta values.