Impact of sacubitril/valsartan on cardiac structure and function in post-acute myocardial infarction heart failure patients aged over 65: a single-center experience

OBJECTIVES: This study evaluates the impact of sacubitril/valsartan on cardiac structure and function in post- acute myocardial infarction (AMI) heart failure (HF) patients over 65 years. METHODS: A retrospective analysis was conducted on 204 HF patients over 65 years who experienced AMI between January 2018 and December 2023. Patients were divided into two groups: sacubitril/valsartan treatment group (n = 103) and enalapril treatment group (n = 101). Baseline characteristics were comparable between the two groups. Echocardiographic evaluations, six-minute walk tests, treatment effects, adverse reactions, and patient satisfaction were assessed over a one-year follow-up period. RESULTS: The sacubitril/valsartan group had bigger decreases in NT-proBNP (P < 0.001) and cTnI (P = 0.030). The sacubitril/valsartan group demonstrated significant improvements in left ventricular ejection fraction (LVEF) (P = 0.002), reduced left ventricular end-diastolic volume (LVEDV) (P = 0.019), and left ventricular end-systolic volume (LVESV) (P = 0.002) when compared to the enalapril group. A substantial increase in six-minute walk test distance was observed in the sacubitril/valsartan group (P = 0.013). The treatment was significantly more effective in the sacubitril/valsartan group compared to the enalapril group (51.46% v.s. 30.69%, P = 0.011). Patient satisfaction was also higher in the sacubitril/valsartan group (P = 0.043). CONCLUSION: Sacubitril/valsartan shows superior efficacy over enalapril in improving cardiac structure, function, exercise capacity, and patient satisfaction in elderly post-AMI HF patients, as evidenced by greater improvements in cardiac function and more pronounced reduction in stress-related biomarkers.