Efficacy of Sacubitril/Valsartan on Mortality in Asymptomatic Hypotensive HFrEF: Data from the China Cardiovascular Association Database-Heart Failure Center Registry

Presenter: Z Qiu

Asymptomatic low blood pressure can limit optimisation of guideline-directed medical therapy in HFrEF, although how this relationship is modified by sacubitril/valsartan (Sac/Val) remains uncertain. This study assessed the association between blood pressure and mortality according to Sac/Val dose using data from 75,816 patients with HFrEF enrolled across 572 hospitals in China between January 1, 2017 and December 31, 2022. During a median follow-up of 21.4 months, 16,466 deaths occurred. Baseline SBP <120 mmHg was associated with increased mortality, but the survival benefit associated with Sac/Val up-titration was preserved across SBP strata. Compared with no RASi, the adjusted HR for ≥50% Sac/Val dose was 0.73 (95% CI: 0.67-0.79) with SBP ≥120 mmHg and 0.52 (95% CI: 0.47-0.58) with SBP <120 mmHg (pinteraction = 0.005). Among 32,674 patients with serial measurements, SBP decrease >10 mmHg was not associated with excess risk when Sac/Val dose was increased or stable.

Prognostic Impact of LV Contractility in Patients Treated with Sacubitril/Valsartan for Heart Failure with Reduced Ejection Fraction

Presenter: T Stegmann

In symptomatic HFrEF, sacubitril/valsartan (S/V) has been associated with improvements in the left ventricular (LV) pressure-volume relationship, while the longer-term trajectory and prognostic relevance of these changes remain uncertain. This prospective registry enrolled 117 patients with NYHA class II–IV HF and LVEF ≤40%, followed for 24 months, with non-invasive pressure-volume loop assessment at baseline, 3, 6, and 12 months. After 12 months, LVEF improved from a median 33% to 44%, while NT-proBNP decreased to 655 pg/ml and only 6 (5%) patients remained in NYHA class III. Ees increased from 0.66 to 0.97 (p<0.001), Ea decreased from 1.75 to 1.55 (p<0.001), and Ea/Ees improved from 2.52 to 1.69 (p<0.001). At 24 months, 16 (13.7%) patients died and 47 (40.2%) experienced at least one HF event. Lower baseline Ees independently predicted mortality (adjusted HR 0.25, 95% CI 0.07-0.95, p=0.041), with approximately 4-fold higher risk among patients with lower values.

Effects of Sacubitril/Valsartan versus Enalapril on NT-proBNP and hs-troponin T in Patients with Heart Failure due to Chagas Disease: Insights from the PARACHUTE-HF Trial

Presenter: L.E Echeverria

In HFrEF due to chronic Chagas cardiomyopathy, NT-proBNP and cardiac troponins are important markers of myocardial wall stress and injury, respectively, with NT-proBNP concentrations below 1000 pg/mL associated with improved outcomes. A PARACHUTE-HF substudy evaluated serial changes in these biomarkers among patients with LVEF ≤40% randomized to sacubitril/valsartan or enalapril alongside standard HF therapy. NT-proBNP was assessed at baseline, Week 12, and Month 8, while hsTnT was measured at baseline and Month 8. Sacubitril/valsartan produced a greater reduction in NT-proBNP than enalapril at Week 12 (mean ratio 0.68; 95% CI 0.62-0.75), sustained at Month 8 (0.76; 95% CI 0.66-0.88). More patients achieved NT-proBNP <1000 pg/mL at Week 12 with sacubitril/valsartan (41.3%) versus enalapril (34.5%; chi-square p=0.045). No significant between-group difference was observed in hsTnT at Month 8 (mean ratio 0.96; 95% CI 0.89–1.04). Overall, sacubitril/valsartan was associated with greater and sustained NT-proBNP reduction in this population.

ESC Congress 2026, 28 - 31 Aug, Munich, Germany