A Study on the Effects of Short-term Sacubitril/Valsartan Treatment on Left Ventricular Functions Using 2D and 3D Echocardiography in Female Patients with Heart Failure with Reduced Ejection Fraction

Objectives: Sacubitril/valsartan (S/V) effects in heart failure with reduced ejection fraction (HFrEF) are well established by 2D Echocardiography in various studies. As there are limited data on S/V effects on left ventricular functions using 3D echocardiography and global longitudinal strain (GLS) specially in the Indian setting, We attempted to assess the impact of a 6-week angiotensin receptor-neprilysin inhibitor (ARNI) regimen on the left ventricular (LV) function in female patients with ejection fraction (EF) <40% (HFrEF) and compared the effects of ARNI in heart failure with reduced ejection fraction (HFrEF) associated with ischemic heart disease (IHD) and Non IHD (NIHD) female patients. We took the help of two-dimensional (2D) echocardiography, three-dimensional (3D) left ventricular ejection fraction (LVEF), and strain parameters. Materials and Methods: We have included 34 patients aged 18–80 years fulfilling all the inclusion and exclusion criteria across the span of 2 months. We measured 2D EF using Simpson’s Biplane method and 2D GLS with automated functional imaging, while also recording 3D LVEF and 3D GLS to get a more complete picture of ventricular function. S/V treatment was initiated for all patients, with the dosage gradually doubled at each biweekly follow-up. Beta blockers and mineralocorticoid receptor antagonists dosages were maintained constant. At the end of 6 weeks, all echocardiographic parameters were reassessed. Results: Both groups (IHD and NIHD) had similar baseline characteristics. At the 6-week follow-up, there was a significant improvement in both 2D and 3D left ventricular longitudinal strain and LVEF in the NIHD group. In the IHD group, a smaller yet significant improvement in LV function was observed, but this was only detectable with 3D EF ( P < 0.05) and GLS parameters ( P < 0.05), not detected with measuring 2D EF ( P = 0.07). Conclusion: In female patients with HFrEF, S/V treatment demonstrated beneficial effects on LVEF and strain parameters. However, the impact on the left ventricular (LV) systolic function varied significantly between ischemic and non-ischemic etiologies, with non-ischemic patients showing the most substantial improvements. In this context, 3D LVEF and GLS offer incremental value over routine 2D in patients with IHD by detecting minute changes in LV function unnoticed by 2D EF measurement. Accordingly, GLS may be employed to detect early functional improvement after brief S/V treatment.