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Background and Objectives:  Evidence for effectiveness of early change from angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) to sacubitril/valsartan is lacking. We aimed to investigate whether early changes to sacubitril/valsartan could improve outcomes in patients with nonischemic dilated cardiomyopathy (DCM) in real-world practice.  Materials and Methods : A total of 296 patients with nonischemic DCM who were treated with ARB or ACEI continuously (group A,  n  = 150) or had their medication switched to sacubitril/valsartan (group S,  n  = 146) were included. The sacubitril/valsartan group was divided into early change (within 60 days, group S/E,  n  = 59) and late change (group S/L,  n  = 87) groups. Changes in echocardiographic parameters from the time of initial diagnosis to the last follow-up were analyzed.  Results : Patients in group S showed greater left ventricular (LV) end-diastolic dimension (EDD) (group A vs. S, 61.7 ± 7.4 vs. 66.5 ± 8.0,  p  < 0.001) and lower LV ejection fraction (LVEF) (28.9 ± 8.2% vs. 23.9 ± 7.5%,  p  < 0.001) than those in group A at initial diagnosis. During a median follow-up of 76 months, patients in group S/E, ∆ LVEF (%) and ∆ LVESD (mm) were significantly improved compared with those in patients in group A (group A vs. S/E, ∆ LVEF,  p  = 0.036; ∆ LVESD,  p  = 0.023) or S/L (group S/E vs. S/L, ∆ LVEF,  p  = 0.05; ∆ LVESD,  p  = 0.005). Among patients whose medications were switched to sacubitril/valsartan, those with an earlier change showed a significant correlation with greater LVEF improvement (r = −0.367,  p  < 0.001) and LV reverse remodeling (r = 0.277,  p  < 0.001).  Conclusions : in patients with nonischemic DCM, an early switch to sacubitril/valsartan was associated with greater improvement in LV function. Patients might benefit in terms of LV function by early switching to sacubitril/valsartan.

Beneficial Effect of Left Ventricular Remodeling after Early Change of Sacubitril/Valsartan in Patients with Nonischemic Dilated Cardiomyopathy