Improvement in Right Ventricular Function and Pulmonary Pressures in Patients With Severe Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction Treated With Sacubitril-Valsartan.

Pulmonary hypertension (PH) significantly impacts outcomes in heart failure with preserved ejection fraction (HFpEF), especially with right ventricular dysfunction (RVD), yet effective treatments are limited. This study retrospectively evaluated sacubitril-valsartan's effects on pulmonary pressures, RV function, and clinical outcomes in 20 severe HFpEF-PH patients. Significant improvements were observed over a median 397-day follow-up. Sacubitril-valsartan notably reduced RV systolic pressure (RVSP) by 27.50 mmHg (p < 0.0001) and peak tricuspid regurgitation (TR) velocity by 0.825 m/s (p < 0.0001). TR severity improved significantly (p = 0.0426). RV dimensions decreased significantly (basal: p = 0.0083; mid-cavity: p = 0.0025). RV-pulmonary arterial coupling (TAPSE/RVSP) improved from 0.27 to 0.47 (p < 0.0001), and NYHA functional class improved from mean III to II (p = 0.0164). Systolic blood pressure also decreased by 24.0 mmHg (p < 0.0001). Diastolic function parameters (E velocity, E/e', LAVI) did not show significant changes. These findings suggest that sacubitril-valsartan could improve pulmonary pressures, RV dimensions, RV-PA coupling, TR severity, and functional status in HFpEF-PH patients, supporting its potential therapeutic role.