Impact of Sacubitril/Valsartan on Cardiac Reverse Remodeling in Patients with Heart Failure Undergoing Cardiac Resynchronization Therapy

<b>Background/Objectives:</b> Many heart failure (HF) patients exhibit a suboptimal response to cardiac resynchronization therapy (CRT). This study investigated whether sacubitril/valsartan, a drug known to beneficially impact cardiac remodeling, could improve outcomes for patients undergoing CRT implantation. <b>Methods:</b> In this single-center, observational study, 90 HF patients (left ventricular ejection fraction [LVEF] ≤ 35%) receiving a CRT-defibrillator were stratified into a sacubitril/valsartan group (<i>n</i> = 39) and a control group (<i>n</i> = 51). The primary endpoint was a CRT response at 12 months, defined as improvement in New York Heart Association (NYHA) class, left ventricular reverse remodeling (≥15% reduction in left ventricular end-systolic volume [LVESV] or ≥5% improvement in LVEF), and freedom from HF hospitalization. <b>Results:</b> The sacubitril/valsartan group had a significantly higher CRT response rate (87.2% vs. 64.7%, <i>p</i> = 0.016). They also showed greater improvement in the 6 min walk test (<i>p</i> = 0.013), NYHA class (<i>p</i> = 0.017), reduction in LVESV (<i>p</i> = 0.025), and QRS duration (<i>p</i> = 0.005). Multivariable analysis confirmed sacubitril/valsartan as an independent predictor of CRT response (OR = 4.43; 95% CI: 1.33-14.71; <i>p</i> = 0.015). <b>Conclusions:</b> In this study of HF patients receiving CRT, sacubitril/valsartan was independently associated with superior reverse remodeling, enhanced electrical resynchronization, and a higher rate of CRT response. These findings suggest a potential synergistic role for sacubitril/valsartan in optimizing post-CRT outcomes; however, as this was an observational study, they should be considered hypothesis-generating and require validation in larger, randomized controlled trials.