Myocardial remodelling during sacubitril/valsartan therapy in patients with chronic heart failure.

Abstract: The aim of the study was to identify differences between aliskiren and sacubitril/valsartan in their ability to influence cardiac remodelling, metabolic balance, neurohumoral activation, and clinical symptom severity. A comparative assessment of the clinical effectiveness and impact on the structural and functional state of the myocardium was conducted for two therapeutic strategies in patients with chronic heart failure in Georgia over a 12-month follow-up. The results demonstrated fundamentally different trajectories of therapeutic response. In the sacubitril/valsartan group, early clinical improvement was observed by 6 months, including significant reductions in systolic blood pressure (-6.2%, p<0.001), respiratory rate (-4.5%, p<0.001), and N-terminal pro-B-type natriuretic peptide levels (-10.0%, p<0.05), along with improved oxygen saturation (+3.5%, p<0.001). Left ventricular ejection fraction increased significantly already at 6 months (from 34.2±4.7% to 37.4±4.0%, p<0.001) and further at 12 months (40.5±3.5%, p<0.001), accompanied by rapid improvement in New York Heart Association functional class, with 9.3% of patients achieving New York Heart Association I by study end. In contrast, the aliskiren group exhibited slower but more pronounced structural reverse remodelling. Significant reductions in left ventricular end-systolic volume (-15.8%, p=0.009), end-diastolic volume (-17.6%, p=0.016), and end-systolic diameter (p=0.002) were observed only at 12 months, along with a modest but significant increase in ejection fraction (p=0.030). Regression of functional mitral and tricuspid regurgitation and a significant decrease in pulmonary artery systolic pressure (-19.7%, p<0.05) were more prominent in this group. Both therapies led to significant improvements in carbohydrate and lipid metabolism, including reductions in glycated haemoglobin, low-density lipoprotein cholesterol, and triglycerides (p<0.05 for all), indicating a favourable systemic metabolic effect. Overall, findings suggest that sacubitril/valsartan may be preferable when rapid clinical stabilization is required, whereas aliskiren may represent an effective therapeutic option for patients with advanced structural cardiac remodelling.