Abstract
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.