{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:34:55Z","timestamp":1791506095662,"version":"4.3.4"},"reference-count":32,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wessex Heartbeat Charity","award":["Grant Number: GA 188191"],"award-info":[{"award-number":["Grant Number: GA 188191"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,11,11]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Heart failure with reduced ejection fraction (HFrEF) guidelines recommend \u2018four pillars\u2019 of medical therapy and device therapy if left ventricular ejection fraction (LVEF) remains \u226435% after 3 months optimum medical therapy.<\/jats:p>\n                  <jats:p>We conducted the first study to examine the effects of optimisation to contemporary medical therapy on cardiac reverse remodelling, as demonstrated by cardiac magnetic resonance imaging (CMR).<\/jats:p>\n                  <jats:p>We hypothesised a proportion of patients would undergo beneficial remodelling and LVEF improvement above the threshold for complex device prescription after 6 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>HFrEF patients with symptomatic LVEF\u226435% despite ACE inhibitor\/beta blocker\/mineralocorticoid receptor antagonist therapy, and qualified for sacubitril\/valsartan switchover were recruited to this single centre prospective study.<\/jats:p>\n                  <jats:p>CMR was performed at baseline and at follow-up. Clinical, volumetric and outcome data were collected and compared.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between June 2021 and August 2022, 49 patients were recruited. The majority (80%) were male, mean age 63\u00b114 years. 35 (71%) had non-ischaemic cardiomyopathy. 2 (4%) patients died and 47 were followed up for a median of 7.4 months. There were no heart failure hospitalisations.<\/jats:p>\n                  <jats:p>Significant reductions were seen in median indexed left atrial volume: 54 mL\/m<jats:sup>2<\/jats:sup> (41\u201372) to 39 mL\/m<jats:sup>2<\/jats:sup> (30\u201360) (p&lt;0.001); indexed left ventricular end-diastolic volume: 109 mL\/m<jats:sup>2<\/jats:sup> (74\u2013125) to 76 mL\/m<jats:sup>2<\/jats:sup> (58\u2013102) (p&lt;0.001); indexed left ventricular end-systolic volume: 74mL\/m<jats:sup>2<\/jats:sup> (50\u201392) to 43 mL\/m<jats:sup>2<\/jats:sup> (27\u201358) (p&lt;0.001) and mean indexed left ventricular mass: 72\u00b113\u2009g\/m<jats:sup>2<\/jats:sup> to 62\u00b113\u2009g\/m<jats:sup>2<\/jats:sup> (p&lt;0.001).<\/jats:p>\n                  <jats:p>Median LVEF increased by 12 points from 31% to 43% (p&lt;0.001). 29 (59%) patients improved to LVEF&gt;35%. 13 (27%) patients improved to LVEF\u226550%.<\/jats:p>\n                  <jats:p>Median N-terminal pro B type natriuretic peptide (NTproBNP) reduced from 883 ng\/L (293\u20132043) to 429 ng\/L (171\u20131421) (p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Optimisation to contemporary HFrEF medical therapy results in beneficial cardiac reverse remodelling and significant improvements in LVEF and NTproBNP at 6 months as demonstrated by CMR. 59% of our cohort no longer met complex device indications. Guidelines suggest re-assessment of LVEF at 3 months, but our data suggests a longer period is required.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05348226\">NCT05348226<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-002933","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T07:30:43Z","timestamp":1733124643000},"page":"e002933","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of optimisation to contemporary HFrEF medical therapy with sacubitril\/valsartan (Entresto) and dapaglifloziN on left Ventricular reverse remodelling as demonstrated by cardiac magnetic resonance (CMR) Imaging: the ENVI study"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct05348226","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-4849","authenticated-orcid":false,"given":"Alice","family":"Zheng","sequence":"first","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Adam","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Peebles","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Harden","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Shambrook","sequence":"additional","affiliation":[{"name":"Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ausami","family":"Abbas","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Vedwan","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Adam","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Haydock","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Cowburn","sequence":"additional","affiliation":[{"name":"Cardiology, University Hospital Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Young","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Long","sequence":"additional","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Walkden","sequence":"additional","affiliation":[{"name":"University Hospital 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