{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T17:27:10Z","timestamp":1778606830362,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>We aimed to compare therapies of sacubitril\/valsartan\u2009+\u2009spironolactone (S\/V\u2009+\u2009S) with angiotensin-converting enzyme inhibitors\u2009+\u2009spironolactone (ACEI\u2009+\u2009S) on the left-sided cardiac reverse remodeling (L-CRR). The second objective was to analyze the usefulness of GLS and LVEF in response to therapy.<\/jats:p><jats:sec><jats:title>Methods<\/jats:title><jats:p>78 patients (mean age 63.4 years, 20 females) with symptomatic heart failure with reduced ejection fraction were randomized to groups of equal numbers, i.e., 39 patients, and started on therapy of S\/V\u2009+\u2009S or ACEI\u2009+\u2009S. Second evaluations were made after 6\u20138 weeks of therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>GLS changed from \u22127.4% to \u22129.4% (18% improvement) in both arms equally. More than 50% of patients, initially with very severe systolic dysfunction (GLS\u2009&amp;gt;\u2009\u22128%), were reclassified to severe (GLS \u22128% to \u221212%). LVEF did not improve in any of the groups. The quality of life measured by MLHFQ and walking distance by 6-MWT increased. Positive correlations between GLS and 6MWT (<jats:italic>r<\/jats:italic>\u2009=\u20090.41, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and GLS and MHFLQ (<jats:italic>r<\/jats:italic>\u2009=\u20090.42, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) were found. The S\/V\u2009+\u2009S subgroup demonstrated improvements in LVEDV (\u039416.7 vs. 4.5\u2005ml), E\/e ratio (\u0394 2.8 vs. 1.4), and LAVI (\u0394 9.4 vs. 8.4\u2005ml\/m<jats:sup>2<\/jats:sup>) as compared to ACEI\u2009+\u2009S.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GLS, unlike LVEF, detects early changes in LV systolic function after 6\u20138 weeks of combined therapy, i.e., SV\u2009+\u2009S and ACE\u2009+\u2009S. GLS is more useful than LVEF in assessing early response to treatment. The effect of S\/V\u2009+\u2009S and ACEI\u2009+\u2009S on LV systolic function was comparable, but the improvement in diastolic function as expressed by E\/e\u2019, LAVI, and LVEDV was more pronounced with S\/V\u2009+\u2009S.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1103688","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T05:21:36Z","timestamp":1680499296000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of early left-sided cardiac reverse remodeling under combined therapy of sacubitril-valsartan and spironolactone compared with angiotensin-converting enzyme inhibitors and 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