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September 14, 2026Scientific ReportsOpen Access

Myocardial contractile reserve by contrast and low-dose dobutamine echocardiography predicts 6-month left ventricular reverse remodeling after sacubitril/valsartan in ischemic cardiomyopathy

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Why the study?

Does myocardial contractile reserve assessed by stress echocardiography predict left ventricular reverse remodeling after 6 months of sacubitril/valsartan therapy in patients with ischemic cardiomyopathy?

Population

174 patients with ischemic cardiomyopathy (ICM) initiating sacubitril/valsartan therapy

Design

Cohort

Follow-up

24 ± 2 weeks

Key result

Baseline myocardial contractile reserve (ΔLVEF) independently predicted left ventricular reverse remodeling at 6 months after sacubitril/valsartan therapy in ischemic cardiomyopathy (OR 1.66).

Authors

XCXudong ChenCLChang LiuYHYun He

Discussion

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Overview

Contractile reserve by stress echo may aid prediction of LV reverse remodeling after sacubitril/valsartan; hypothesis-generating pending prospective validation in ischemic cardiomyopathy.

Key Points

  • To evaluate whether myocardial contractile reserve measured by contrast and low-dose dobutamine stress echocardiography predicts 6-month left ventricular reverse remodeling in patients with ischemic cardiomyopathy receiving sacubitril/valsartan.
  • Enrolled 174 patients with ischemic cardiomyopathy initiating sacubitril/valsartan (164 completed 24 ± 2 weeks of follow-up).
  • Assessed baseline contractile reserve via left heart contrast and low-dose dobutamine stress echocardiography, measuring changes in ejection fraction (ΔLVEF), wall motion score index (ΔWMSI), and reserve-positive segments.
  • Defined left ventricular reverse remodeling (LVRR) as a ≥ 15% decrease in left ventricular end-systolic volume index at 24 weeks.
  • At follow-up, 40.85% of patients (67/164) achieved LVRR and exhibited significantly higher baseline ΔLVEF, lower ΔWMSI, and more reserve-positive segments than non-responders (all P < 0.05).
  • Multivariable logistic regression showed that ΔLVEF, ΔWMSI, and positive segment count independently predicted LVRR (all P < 0.001), with AUCs of 0.84, 0.80, and 0.82, respectively.
  • Incorporating ΔLVEF into the baseline clinical model significantly improved discriminative ability for LVRR, boosting the AUC from 0.70 to 0.88 (P < 0.001).

Study Design

Type

Cohort (n=174)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does myocardial contractile reserve assessed by stress echocardiography predict left ventricular reverse remodeling after 6 months of sacubitril/valsartan therapy in patients with ischemic cardiomyopathy?

P
Population
174 adults aged 18-80 years with ischemic cardiomyopathy and LVEF ≤ 40% initiating sacubitril/valsartan, followed for 24 weeks.
E
Exposure
Assessment of myocardial contractile reserve using left heart contrast echocardiography and low-dose dobutamine stress echocardiography before treatment
O
Outcome
Left ventricular reverse remodeling (LVRR), defined as a ≥ 15% reduction in left ventricular end-systolic volume index (LVESVI) at 24 ± 2 weeks compared with baselinesurrogate

Main Result

Odds Ratio: 1.66 (95% CI 1.32–2.08)

p-value: p=<0.001

Myocardial contractile reserve assessed by stress echocardiography strongly predicts left ventricular reverse remodeling after 6 months of sacubitril/valsartan therapy in patients with ischemic cardiomyopathy.

Limitations

  • Single-center study design
  • Lack of a comparator treatment group to demonstrate sacubitril/valsartan-specific treatment response
  • Did not integrate echocardiographic contractile reserve with CMR-derived indices of scar burden
  • Because all participants received sacubitril/valsartan, these findings should not be interpreted as demonstrating treatment-specific response classification

Cite This Study

Chen et al. (2026) conducted a cohort in Ischemic cardiomyopathy (n=174). Myocardial contractile reserve (ΔLVEF) vs. Lower contractile reserve was evaluated on Left ventricular reverse remodeling (≥ 15% reduction in LVESVI) at 24 ± 2 weeks (OR 1.66, 95% CI 1.32-2.08, p=<0.001). Baseline myocardial contractile reserve (ΔLVEF) independently predicted left ventricular reverse remodeling at 6 months after sacubitril/valsartan therapy in ischemic cardiomyopathy (OR 1.66).

synapsesocial.com/papers/6aa7afef79e9260bc85aad02https://doi.org/10.1038/s41598-026-65842-5
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