The positive effect of sacubitril/valsartan therapy on QRS width and QTC interval on electrocardiogram in heart failure patients with reduced ejection fraction

Abstract

Sacubitril/valsartan (S/V) therapy has been found to reduce hospitalizations, improve echocardiogram parameters and improve mortality in heart failure patients with reduced ejection fraction (HFrEF), defined as EF <40% . S/V therapy was also associated with a significant decrease in ventricular tachycardia episodes and premature ventricular contraction .The exact mechanism by which S/V therapy reduced ventricular arrhythmias is unclear. It is unclear whether this reduction is due to reversal remodeling, a decrease in cardiac fibrosis , wall stretch, or sympathetic nervous system activation or even reversal electrical remodeling.

The goal of this research was to determinate how SV medication affected electrocardiogram parameters such as QRS width and QTc interval in patinets with HFrEF, a marker for reverse electrical remodeling.

35 patients with HFrEF, middle age 68,9±7,8 year, underwent standardized 12-lead Holter-ECG, echocardiography and laboratory testing before and 3 months after start of therapy. The QRS widht was reduced from 121,7±18,7 ms to 116,5±17,5 ms, p<0,05 and QTc interval was reduced from 427,5±33,8 ms to 422,5±33,4 ms, p<0,05. Echocardiography demonstrated a sinignificant increase in left ventricular ejection fraction (31,2±8,8% vs. 42,6±11,1% p<0,01). QRS width and QTc interval had a negative connection with EF.

Our study has shown that in HfrEf patients sacubitiril/valsartan treatment lead to a significant decrease in QRS and QTC interval duration. This is an indication of reverse electrical left ventricular remodeling and can be used an auxillary predictor for tracking therapy outcomes.