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Valsartan for Heart Failure
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The Journal of Heart and Lung Transplantation, Vol 39, No 4S, April 2020
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also not different between the two groups. Within 1 year after HTX listing patients in both groups did not differ in rates of HTX (48% in Group A vs. 50% in Group B, P=0.88), LVAD implantation (0% in Group A vs. 4% in Group B, P=0.25), or total mortality (3% vs. 10%; p=0.16). However, in Group A, 24% of patients were delisted due to clinical improvement; compared to only 9% of patients in Group B (P=0.005). At the time of HTX listing, the delisted patients displayed similar clinical characteristics than the remaining cohort (LVEF: 22§2% in the delisted vs. 23§4% in the remaining cohort, P=0.67; NT-proBNP: 2822§1198 pg/mL vs. 3983§ 3927, P=0.45, ishemic heart failure etiology: 43% vs. 39%, P=0.77, history of hypertension: 61% vs. 58%; P=0.82; renal dysfunction: 31% vs. 25%, P=0.44 or diabetes: 20% vs 27%, P=0.52). On multivariate analysis, cell therapy was an independent correlate of delisting (P=0.002). Conclusion: CD 34+ cell therapy appears to be associated with beneficial clinical outcomes and increased rates of delisting in advanced heart failure patients awaiting heart transplantation.
Quality of Life Outcomes of Patients Receiving Palliative, Long-Term Continuous Intravenous Inotropic Support D. Stewart, A. Rao and H. Groninger. Department of Palliative Care, MedStar Washington Hospital Center, Washington, DC. Purpose: Long-term, continuous intravenous inotropic support (CIIS) is frequently initiated for palliation of symptoms related to advanced heart failure (AHF) in patients who are not eligible for heart transplantation or mechanical circulatory support (MCS). Although the use of CIIS has increased in prevalence over the past decade, robust data regarding quality of life (QOL) outcomes in these patients are lacking. We wished to describe healthcare utilization and QOL outcomes in patients on palliative CIIS. Methods: Retrospective analysis of inpatients followed by the AHF service at MedStar Washington Hospital Center who were started on palliative CIIS between 2014 and 2016. Patients were excluded if they were being worked up for transplantation or MCS at the time of initiation. EHR were queried to obtain patient demographics, duration of CIIS, readmissions and emergency room encounters, transfer to an intensive care unit (ICU), code status at the time of initiation, documented goals of care discussions, palliative care consultation, and hospice referral. Data was analyzed using descriptive statistics. Results: We identified 72 patients that fit the criteria for the study with a median of 106 days on CIIS (range 4-726 days). 68 patients (94%) began CIIS as full code and 5 (6%) as do not resuscitate/do not intubate (DNR/ DNI). Fifty percent of those starting as full code changed to DNR/DNI and 22% remained full code until death. There was an average of 2.4 +/- 2.4 hospital readmissions, 0.7 +/- 1.2 ER visits, and 22.5 +/- 22.7 hospital days (range 0-126 days) during CIIS. Thirty three percent of patients admitted to the hospital were transferred to the ICU at least once. Ninety five percent of patients had documented goals of care discussions and 69% had a palliative care consult; however, only 58% were referred to hospice. Conclusion: Patients in this cohort had high healthcare utilization. Although the majority of patients on CIIS had documented goals of care, we observed significant variation in palliative care and hospice involvement. This data may assist clinicians with educating and setting expectations for patients when initiation of CIIS is considered. Future studies should assess symptom benefit of CIIS, associated risks including central line infection and implanted cardioverter-defibrillator shocks, and explore barriers to hospice enrollment. (575) WITHDRAWN (576) Clinical Effects of CD34+ Cell Therapy in Advanced Chronic Heart Failure Patients Listed for Heart Transplantation stjen, G. Poglajen, S. Frljak, G. Zemljic, R. Okrajsek, A. Cerar, M. Sebe V. Androcec and B. Vrtovec. Advanced Heart Failure and Transplantation Center, University Medical Center, Ljubljana, Slovenia. Purpose: Data on cell therapy in heart failure patients listed for heart transplantation (HTX) are lacking. We sought to investigate the clinical effects of CD34+ cell therapy in this patient cohort. Methods: In a single-center retrospective study we analysed data of all patients listed for heart transplantation between 2007 and 2017. Pediatric patients (<18 years), patients with congenital heart disease, mechanical circulatory support, and patients awaiting multi-organ transplantation were excluded. Of 372 patients included, 33 patients (Group A) received CD34+ cell therapy, and 339 (Group B) received optimal medical management. Patients were followed for 1 year; the primary end-point was the rate of delisting from HTX elective waiting list. Results: At the time of HTX listing the two groups did not differ in age (56§7 years in Group A vs. 54§10 years in Group B, P=0.24), gender (male: 100% vs. 80%, P=0.12), heart failure etiology (ishemic; 44% vs. 39%; P=0.55), history of hypertension (61% vs. 59%; P=0.99), renal dysfunction (33% vs. 23%, P=0.46) or diabetes (26% vs 24%, P=0.80). Left ventricular ejection fraction (LVEF: 22§3% vs. 24§4%, P=0.15) and NTproBNP levels (3524§3821 pg/mL vs. 4048§3482 pg/mL, P=0.64) were
(577) Initial Experience in Adults with Complex Congenital Heart Disease Treated with Sacubitril/Valsartan for Heart Failure T.L. Goodwin, C.R. Broda, A. Opina, W. Lam and P.R. Ermis. Pediatric and Adult Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. Purpose: Adults with congenital heart disease (ACHD) are an emerging population. Heart failure (HF) is a major cause of morbidity and mortality for ACHD. Sacubitril/valsartan has been shown to reduce the risk of hospitalizations and death from HF in acquired cardiovascular disease but there is little information available on its effect on HF in ACHD. Methods: We retrospectively studied patients with complex congenital heart disease (CHD) who were prescribed sacubitril/valsartan to treat HF. Data collected includes New York Heart Association (NYHA) classification, laboratory data, vital signs, and imaging by echocardiogram. Results: Eight ACHD patients with HF with a median age of 40.6 [IQR 33.352.8] years were treated with sacubitril/valsartan for a median duration of 269 [IQR 102-473] days. Five (62.5%) had a systemic right ventricle and 3
Abstracts (37.5%) had single ventricle anatomy. Five (62.5%) had severe systemic systolic ventricular dysfunction. At time of last follow-up, 3 (37.5%) patients at NYHA III had no change in functional class, 4 (50%) patients at NYHA IV improved to NYHA II. One patient has not yet returned for follow-up to evaluate functional status. No patients were noted to have a substantial change in renal function or potassium levels. Median brain natriuretic peptide values pre and post- sacubitril/valsartan were 2517 pg/mL and 1040 pg/mL, respectively. Median mean arterial pressures pre and post-sacubitril/valsartan were 83 mmHg and 77 mmHg, respectively. One (12.5%) patient required dose reduction due to hypotension. At time of last follow-up, 2 (25%) achieved 97 mg/ 100 mg dose of sacubitril/valsartan. No patients experienced symptoms related to angioedema. Conclusion: In a small cohort of adults with complex CHD and HF, sacubitril/valsartan was well-tolerated, with some patients experiencing improvement in NYHA class. More studies and a registry of outcomes of sacubitril/valsartan use in ACHD are needed.
(578) Case Report: Percutaneous Mitral Valve Repair in a Patient with Fontan Repair for a Single Functional Ventricle R.J. Donovan,1 S. Lim,1 and W.R. Davidson.2 1UVA Medical Center, Charlottesville, VA; and the 2Penn State Medical Center, Hershey, PA. Purpose: Mitral regurgitation (MR) can complicate congenital heart disease, particularly when secondary to left ventricular dysfunction and mitral annular dilation. Significant MR is associated with substantial morbidity and mortality in patients with reduced LV systolic function, with recent studies demonstrating that percutaneous mitral valve repair can significantly reduce hospitalizations and all-cause mortality. Methods: A 31 year-old man was referred to our Advanced Valve center for evaluation and management of significant MR. He was born with pulmonary atresia and was palliated by oversewing the tricuspid valve and creating Fontan physiology using an intracardiac lateral tunnel. At the age of 30 he presented with fatigue with an echo that showed an LV EF of 4045% with severe MR. He was evaluated for transplantation at his referring facility but was not felt to be a candidate and was referred to our clinic for consideration of valvular intervention. Results: Following TEE and CT evaluations, he was deemed to be a candidate for transcutaneous mitral valve repair, with functional etiology of his MR. Following femoral venous access, a transseptal puncture was made across the lateral tunnel of the patient’s Fontan circuit. A steerable guide catheter was then introduced into the left atrium and percutaneous transcatheter mitral valve repair was performed using the MitraClip system (4 clips on A2/P2 scallops), with reduction in the MR from severe to mild. The patient tolerated the procedure well with no significant complications. After the procedure, the patient reported improvement in his symptoms of dyspnea and fatigue with sustained clinical improvement several months later (NYHA class II). Conclusion: Transcatheter mitral valve repair is an accepted method for the treatment of severe MR and its symptoms in patients with both functional and degenerative MR. To our knowledge, this experience represents the first case report of this new technology being used in the treatment of congenital heart disease patients with single ventricle physiology. Given the challenges of surgical repair in this population and the increasing number of patients living into adulthood with congenital heart disease, we believe that transcatheter valvular interventions will become an important tool for the care of these complex patients.
(579) Outcomes on the Waiting List for Candidates Receiving an Angiotensin Receptor-Neprilysin Inhibitor at Listing C. Jasseron, R. Dorent, O. Bastien and C. Legeai. Agence de la Biomedecine, Saint-Denis la Plaine, France. Purpose: The angiotensin receptor-neprilysin inhibitor, sacubitril-valsartan (SV), is indicated in patients with heart failure with reduced ejection fraction. The use of SV reduced the risk of death and of hospitalization for heart failure as compared to enalapril therapy in outpatients with NYHA class II-III symptoms. This study aimed to assess the outcomes of heart transplant candidates receiving SV at listing.
S239 Methods: All candidates listed for transplantation between January 2018 and March 2019 on the French registry CRISTAL were included. Candidates on VA-ECMO, long-term MCS and inotropic support at listing were excluded. Patients receiving SV at listing (study group, n=151) were compared to patients not receiving SV (control group, n=249). The main outcome was 6-month waitlist mortality or delisting for worsening medical condition. The secondary outcomes were 6-month rates of hospitalization and need for circulatory support. Survival curves were estimated using the Kaplan-Meier method. Association of SV use with the main outcome was evaluated with multivariable Cox proportional hazards model. Results: Patients from the study group were older and more likely to have dilated or ischemic cardiomyopathy. They had lower glomerular filtration rate, NT-proBNP concentration and serum bilirubin level. Their 1-year access to transplantation was significantly lower (56% vs 71%, p=0.003). The 6-month survival rate tended to be higher in the study group (95.2% vs 89.3%, p=0.11). In the multivariable Cox model, lack of SV use was non significantly associated with higher 6-month waitlist mortality (HR 1.9; p = 0.2). The 6-month rate of hospitalization and need for circulatory support did not differ between the groups. Conclusion: Use of SV at listing is frequent in contemporary heart transplant candidates without circulatory support. Our findings suggest that SV use may be associated with reduced risk of waitlist mortality without effect on hospitalization rate.
(580) Impact of Sacubitril/Valsartan in Cardiac Reverse Remodeling in Ischemic vs. Nonischemic Cardiomyopathy O. Safdar,1 A. Ervin,2 S. Cozzi,2 I. Danelich,2 M. Shah,2 A. Vishnevsky,2 R. Alvarez,2 and P. Pirlamarla.2 1Internal Medicine, Thomas Jefferson University, Philadelphia, PA; and the 2Cardiology, Thomas Jefferson University, Philadelphia, PA. Purpose: Guideline directed medical therapy with beta blockers, ACEi/ ARBs, and aldosterone antagonists with the goal of affecting cardiac reverse remodeling (CRR) has previously been the cornerstone of management of patients with heart failure with reduced ejection fraction (HFrEF). More recently, PARADIGM-HF demonstrated the superiority of sacubitril-valsartan to enalapril in reducing HF hospitalizations as well as cardiac and all-cause mortality. Other studies demonstrated that ARNI therapy may enhance CRR to a greater degree than ACEI or ARB therapy alone. To date, the degree of CRR in nonischemic vs ischemic cardiomyopathy treated with ARNI has not been studied. Methods: A single-center retrospective chart review was performed assessing the effect of ARNI on echocardiographic parameters of CRR. Patients initiated on any dose sacubitril-valsartan from January 1, 2016 to October 1, 2019 were included. Baseline demographic and clinical information was collected. Serial echocardiograms performed at 3 month intervals following initiation of therapy were reviewed for markers of cardiac remodeling including ejection fraction (LVEF), left ventricular internal diameter end diastole and end systole (LVESD, LVEDD), and left ventricular mass index (LVMI). Results: Of the 76 patients included in the analysis, 29 (38%) had ICM and 47 (72%) had NICM with a median age of 61.5. Both groups were treated with maximally tolerated doses of guideline directed medical therapy. There was no difference in the percentage of patients in each cohort treated
The Journal of Heart and Lung Transplantation, Vol 39, No 4S, April 2020
(574)
also not different between the two groups. Within 1 year after HTX listing patients in both groups did not differ in rates of HTX (48% in Group A vs. 50% in Group B, P=0.88), LVAD implantation (0% in Group A vs. 4% in Group B, P=0.25), or total mortality (3% vs. 10%; p=0.16). However, in Group A, 24% of patients were delisted due to clinical improvement; compared to only 9% of patients in Group B (P=0.005). At the time of HTX listing, the delisted patients displayed similar clinical characteristics than the remaining cohort (LVEF: 22§2% in the delisted vs. 23§4% in the remaining cohort, P=0.67; NT-proBNP: 2822§1198 pg/mL vs. 3983§ 3927, P=0.45, ishemic heart failure etiology: 43% vs. 39%, P=0.77, history of hypertension: 61% vs. 58%; P=0.82; renal dysfunction: 31% vs. 25%, P=0.44 or diabetes: 20% vs 27%, P=0.52). On multivariate analysis, cell therapy was an independent correlate of delisting (P=0.002). Conclusion: CD 34+ cell therapy appears to be associated with beneficial clinical outcomes and increased rates of delisting in advanced heart failure patients awaiting heart transplantation.
Quality of Life Outcomes of Patients Receiving Palliative, Long-Term Continuous Intravenous Inotropic Support D. Stewart, A. Rao and H. Groninger. Department of Palliative Care, MedStar Washington Hospital Center, Washington, DC. Purpose: Long-term, continuous intravenous inotropic support (CIIS) is frequently initiated for palliation of symptoms related to advanced heart failure (AHF) in patients who are not eligible for heart transplantation or mechanical circulatory support (MCS). Although the use of CIIS has increased in prevalence over the past decade, robust data regarding quality of life (QOL) outcomes in these patients are lacking. We wished to describe healthcare utilization and QOL outcomes in patients on palliative CIIS. Methods: Retrospective analysis of inpatients followed by the AHF service at MedStar Washington Hospital Center who were started on palliative CIIS between 2014 and 2016. Patients were excluded if they were being worked up for transplantation or MCS at the time of initiation. EHR were queried to obtain patient demographics, duration of CIIS, readmissions and emergency room encounters, transfer to an intensive care unit (ICU), code status at the time of initiation, documented goals of care discussions, palliative care consultation, and hospice referral. Data was analyzed using descriptive statistics. Results: We identified 72 patients that fit the criteria for the study with a median of 106 days on CIIS (range 4-726 days). 68 patients (94%) began CIIS as full code and 5 (6%) as do not resuscitate/do not intubate (DNR/ DNI). Fifty percent of those starting as full code changed to DNR/DNI and 22% remained full code until death. There was an average of 2.4 +/- 2.4 hospital readmissions, 0.7 +/- 1.2 ER visits, and 22.5 +/- 22.7 hospital days (range 0-126 days) during CIIS. Thirty three percent of patients admitted to the hospital were transferred to the ICU at least once. Ninety five percent of patients had documented goals of care discussions and 69% had a palliative care consult; however, only 58% were referred to hospice. Conclusion: Patients in this cohort had high healthcare utilization. Although the majority of patients on CIIS had documented goals of care, we observed significant variation in palliative care and hospice involvement. This data may assist clinicians with educating and setting expectations for patients when initiation of CIIS is considered. Future studies should assess symptom benefit of CIIS, associated risks including central line infection and implanted cardioverter-defibrillator shocks, and explore barriers to hospice enrollment. (575) WITHDRAWN (576) Clinical Effects of CD34+ Cell Therapy in Advanced Chronic Heart Failure Patients Listed for Heart Transplantation stjen, G. Poglajen, S. Frljak, G. Zemljic, R. Okrajsek, A. Cerar, M. Sebe V. Androcec and B. Vrtovec. Advanced Heart Failure and Transplantation Center, University Medical Center, Ljubljana, Slovenia. Purpose: Data on cell therapy in heart failure patients listed for heart transplantation (HTX) are lacking. We sought to investigate the clinical effects of CD34+ cell therapy in this patient cohort. Methods: In a single-center retrospective study we analysed data of all patients listed for heart transplantation between 2007 and 2017. Pediatric patients (<18 years), patients with congenital heart disease, mechanical circulatory support, and patients awaiting multi-organ transplantation were excluded. Of 372 patients included, 33 patients (Group A) received CD34+ cell therapy, and 339 (Group B) received optimal medical management. Patients were followed for 1 year; the primary end-point was the rate of delisting from HTX elective waiting list. Results: At the time of HTX listing the two groups did not differ in age (56§7 years in Group A vs. 54§10 years in Group B, P=0.24), gender (male: 100% vs. 80%, P=0.12), heart failure etiology (ishemic; 44% vs. 39%; P=0.55), history of hypertension (61% vs. 59%; P=0.99), renal dysfunction (33% vs. 23%, P=0.46) or diabetes (26% vs 24%, P=0.80). Left ventricular ejection fraction (LVEF: 22§3% vs. 24§4%, P=0.15) and NTproBNP levels (3524§3821 pg/mL vs. 4048§3482 pg/mL, P=0.64) were
(577) Initial Experience in Adults with Complex Congenital Heart Disease Treated with Sacubitril/Valsartan for Heart Failure T.L. Goodwin, C.R. Broda, A. Opina, W. Lam and P.R. Ermis. Pediatric and Adult Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. Purpose: Adults with congenital heart disease (ACHD) are an emerging population. Heart failure (HF) is a major cause of morbidity and mortality for ACHD. Sacubitril/valsartan has been shown to reduce the risk of hospitalizations and death from HF in acquired cardiovascular disease but there is little information available on its effect on HF in ACHD. Methods: We retrospectively studied patients with complex congenital heart disease (CHD) who were prescribed sacubitril/valsartan to treat HF. Data collected includes New York Heart Association (NYHA) classification, laboratory data, vital signs, and imaging by echocardiogram. Results: Eight ACHD patients with HF with a median age of 40.6 [IQR 33.352.8] years were treated with sacubitril/valsartan for a median duration of 269 [IQR 102-473] days. Five (62.5%) had a systemic right ventricle and 3
Abstracts (37.5%) had single ventricle anatomy. Five (62.5%) had severe systemic systolic ventricular dysfunction. At time of last follow-up, 3 (37.5%) patients at NYHA III had no change in functional class, 4 (50%) patients at NYHA IV improved to NYHA II. One patient has not yet returned for follow-up to evaluate functional status. No patients were noted to have a substantial change in renal function or potassium levels. Median brain natriuretic peptide values pre and post- sacubitril/valsartan were 2517 pg/mL and 1040 pg/mL, respectively. Median mean arterial pressures pre and post-sacubitril/valsartan were 83 mmHg and 77 mmHg, respectively. One (12.5%) patient required dose reduction due to hypotension. At time of last follow-up, 2 (25%) achieved 97 mg/ 100 mg dose of sacubitril/valsartan. No patients experienced symptoms related to angioedema. Conclusion: In a small cohort of adults with complex CHD and HF, sacubitril/valsartan was well-tolerated, with some patients experiencing improvement in NYHA class. More studies and a registry of outcomes of sacubitril/valsartan use in ACHD are needed.
(578) Case Report: Percutaneous Mitral Valve Repair in a Patient with Fontan Repair for a Single Functional Ventricle R.J. Donovan,1 S. Lim,1 and W.R. Davidson.2 1UVA Medical Center, Charlottesville, VA; and the 2Penn State Medical Center, Hershey, PA. Purpose: Mitral regurgitation (MR) can complicate congenital heart disease, particularly when secondary to left ventricular dysfunction and mitral annular dilation. Significant MR is associated with substantial morbidity and mortality in patients with reduced LV systolic function, with recent studies demonstrating that percutaneous mitral valve repair can significantly reduce hospitalizations and all-cause mortality. Methods: A 31 year-old man was referred to our Advanced Valve center for evaluation and management of significant MR. He was born with pulmonary atresia and was palliated by oversewing the tricuspid valve and creating Fontan physiology using an intracardiac lateral tunnel. At the age of 30 he presented with fatigue with an echo that showed an LV EF of 4045% with severe MR. He was evaluated for transplantation at his referring facility but was not felt to be a candidate and was referred to our clinic for consideration of valvular intervention. Results: Following TEE and CT evaluations, he was deemed to be a candidate for transcutaneous mitral valve repair, with functional etiology of his MR. Following femoral venous access, a transseptal puncture was made across the lateral tunnel of the patient’s Fontan circuit. A steerable guide catheter was then introduced into the left atrium and percutaneous transcatheter mitral valve repair was performed using the MitraClip system (4 clips on A2/P2 scallops), with reduction in the MR from severe to mild. The patient tolerated the procedure well with no significant complications. After the procedure, the patient reported improvement in his symptoms of dyspnea and fatigue with sustained clinical improvement several months later (NYHA class II). Conclusion: Transcatheter mitral valve repair is an accepted method for the treatment of severe MR and its symptoms in patients with both functional and degenerative MR. To our knowledge, this experience represents the first case report of this new technology being used in the treatment of congenital heart disease patients with single ventricle physiology. Given the challenges of surgical repair in this population and the increasing number of patients living into adulthood with congenital heart disease, we believe that transcatheter valvular interventions will become an important tool for the care of these complex patients.
(579) Outcomes on the Waiting List for Candidates Receiving an Angiotensin Receptor-Neprilysin Inhibitor at Listing C. Jasseron, R. Dorent, O. Bastien and C. Legeai. Agence de la Biomedecine, Saint-Denis la Plaine, France. Purpose: The angiotensin receptor-neprilysin inhibitor, sacubitril-valsartan (SV), is indicated in patients with heart failure with reduced ejection fraction. The use of SV reduced the risk of death and of hospitalization for heart failure as compared to enalapril therapy in outpatients with NYHA class II-III symptoms. This study aimed to assess the outcomes of heart transplant candidates receiving SV at listing.
S239 Methods: All candidates listed for transplantation between January 2018 and March 2019 on the French registry CRISTAL were included. Candidates on VA-ECMO, long-term MCS and inotropic support at listing were excluded. Patients receiving SV at listing (study group, n=151) were compared to patients not receiving SV (control group, n=249). The main outcome was 6-month waitlist mortality or delisting for worsening medical condition. The secondary outcomes were 6-month rates of hospitalization and need for circulatory support. Survival curves were estimated using the Kaplan-Meier method. Association of SV use with the main outcome was evaluated with multivariable Cox proportional hazards model. Results: Patients from the study group were older and more likely to have dilated or ischemic cardiomyopathy. They had lower glomerular filtration rate, NT-proBNP concentration and serum bilirubin level. Their 1-year access to transplantation was significantly lower (56% vs 71%, p=0.003). The 6-month survival rate tended to be higher in the study group (95.2% vs 89.3%, p=0.11). In the multivariable Cox model, lack of SV use was non significantly associated with higher 6-month waitlist mortality (HR 1.9; p = 0.2). The 6-month rate of hospitalization and need for circulatory support did not differ between the groups. Conclusion: Use of SV at listing is frequent in contemporary heart transplant candidates without circulatory support. Our findings suggest that SV use may be associated with reduced risk of waitlist mortality without effect on hospitalization rate.
(580) Impact of Sacubitril/Valsartan in Cardiac Reverse Remodeling in Ischemic vs. Nonischemic Cardiomyopathy O. Safdar,1 A. Ervin,2 S. Cozzi,2 I. Danelich,2 M. Shah,2 A. Vishnevsky,2 R. Alvarez,2 and P. Pirlamarla.2 1Internal Medicine, Thomas Jefferson University, Philadelphia, PA; and the 2Cardiology, Thomas Jefferson University, Philadelphia, PA. Purpose: Guideline directed medical therapy with beta blockers, ACEi/ ARBs, and aldosterone antagonists with the goal of affecting cardiac reverse remodeling (CRR) has previously been the cornerstone of management of patients with heart failure with reduced ejection fraction (HFrEF). More recently, PARADIGM-HF demonstrated the superiority of sacubitril-valsartan to enalapril in reducing HF hospitalizations as well as cardiac and all-cause mortality. Other studies demonstrated that ARNI therapy may enhance CRR to a greater degree than ACEI or ARB therapy alone. To date, the degree of CRR in nonischemic vs ischemic cardiomyopathy treated with ARNI has not been studied. Methods: A single-center retrospective chart review was performed assessing the effect of ARNI on echocardiographic parameters of CRR. Patients initiated on any dose sacubitril-valsartan from January 1, 2016 to October 1, 2019 were included. Baseline demographic and clinical information was collected. Serial echocardiograms performed at 3 month intervals following initiation of therapy were reviewed for markers of cardiac remodeling including ejection fraction (LVEF), left ventricular internal diameter end diastole and end systole (LVESD, LVEDD), and left ventricular mass index (LVMI). Results: Of the 76 patients included in the analysis, 29 (38%) had ICM and 47 (72%) had NICM with a median age of 61.5. Both groups were treated with maximally tolerated doses of guideline directed medical therapy. There was no difference in the percentage of patients in each cohort treated