Royal College of Surgeons in Ireland
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Electrocardiographic predictors of response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction

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journal contribution
posted on 2024-05-03, 15:32 authored by Jonathan Shpigelman, Ciara Blaine, Carol-Ann Nugent, Louise Kiernan, Caitriona CahirCaitriona Cahir, Benjamin Mac Curtain, Amir Bachari, Wadeed Irfan, Patrick O'BoylePatrick O'Boyle, James O'Neill, Michael DalyMichael Daly

Background: Sacubitril/valsartan (SV) is currently recommended as a first-line therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to its significant clinical and prognostic benefit; however, not all patients respond to therapy and predictors of clinical response to SV remain under-studied.

Aims: To identify electrocardiographic (ECG) predictors of response to SV therapy in HFrEF patients.

Methods: A retrospective analysis of a hospital heart failure registry was undertaken. Consecutive HFrEF patients (New York Heart Association class II-III) on maximal-dose SV were studied. Response to SV was defined as ≥10% relative improvement in left ventricular ejection fraction (LVEF) at 3-months post-maximal-dose therapy. Pre-therapy ECGs were retrospectively analyzed for axes and standard wave and interval durations. Logistic regression was used to estimate odds ratios and 95% confidence intervals for associations between predictors and therapeutic response. Backward stepwise regression was employed to develop a parsimonious model.

Results: P-wave duration (PWD) 100-120 ms, PWD >120 ms, and QTc >460 ms were associated with response to SV on univariate analysis: OR 18.00 (4.45-122.90), 5.00 (1.47-20.42), and 3.10 (1.18-9.22), respectively. The preferred model that included the former two predictors in combination with pre-therapy creatinine, mineralocorticoid receptor antagonist use, and LVEF was highly selective (area under the ROC curve = 0.868).

Conclusions: Prolongation of both PWD and QTc interval on baseline ECG in HFrEF patients is predictive of therapeutic response to maximal-dose SV therapy and may indicate early cardiac remodeling that is highly amenable to reversal



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Published Citation

Shpigelman J. et al. Electrocardiographic predictors of response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction. J Electrocardiol. 2024;84:104-108.

Publication Date

26 March 2024

PubMed ID



  • Data Science Centre
  • School of Medicine
  • Undergraduate Research
  • School of Population Health

Research Area

  • Health Professions Education


Elsevier BV


  • Published Version (Version of Record)