الفهرس 
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Abstract
The aim of our research was to investigate the effect of Sacubitril/ valsartan drug on a noninvasive cardiovascular risk stratifier HRT that proved to be strongest predictor of morbidity and mortality in patients with heart failure with reduced ejection fraction.
The benefits of such work are to evaluate improvement of HRT and predictable mortality, even sudden cardiac death in patients with heart failure with reduced ejection fraction.
The study enrolled 42 patients with Heart failure with reduced ejection fraction LVEF ≤35 % .
Those patients were in Minia Heath Insurance Hospital during period from November 2022 to July 2023 .
All patients were subjected to the following before starting sacubitril / valsartan:
1- History taking.
2- Clinical examination.
3- Labs included (LDL., serum creatinine, serum K)
4- Echocardiography
5- 24 hrs. Holter ECG
All patients were followed up after 3 months of continuous therapy of sacubitril / valsartan in addition to Labs , Echocardiography and 24 hrs. Holter were re- made .
A comparative comparison was done between HRT before and after sacubitril / valsartan treatment .
Also , we compared Labs , other Holter parameters and improvement of ejection fraction and other cardiac structures .
Patients were classified into two categories based on base line HRT Score 2 groups before starting sacubitril / valsartan:
- Category baseline HRT Score 2 included 20 cases.
- Category baseline HRT Score 0/1 included 22 cases.
Then they were classified according to HRT score after sacubitril/ valsartan treatment follow up into 4 groups:
• group 1 that was baseline HRT Score 2 and remained Score 2, included 12 cases.
• group 2 that was baseline HRT Score 0/1 and remained score 0/1, included 15 cases.
• group 3 that was baseline HRT Score 2 and changed to score 0/1, included 8 cases.
• group 4 that was baseline HRT Score 0/1 and changed to score 2, included 7 cases.
The study demonstrate that :
- group 1: 6 cases improved EF and 6 cases did not improve EF but not complicated.
- group 2: only one case improved EF & 14 cases not improved . 9 cases non improved ones complicated (3 of them died and the other developed VT and Runs of Salvos and PVCs more than 10 % ).
- group 3 : 3 cases improved EF and 5 cases not improved but no complications occurred .
- group 4 : only one case improved and one case complicated of non-improved 6 cases.
SO, we could say that:
• Baseline HRT score 2 is the lowest risk of developing complication and predicts the best outcome in improvement ejection fraction and other cardiac structures after sacubitril / valsartan.
• Baseline HRT score 0 /1 is the highest risk of developing complications after sacubitril / valsartan.
• HRT score did not improve after 3 months of continuous sacubitril / valsartan therapy but could predict the development of complications of occurrence .
• Complications that observed in our study were :
- Sudden death
- Runs of Salvos
- Frequent PVCs more than 10 %
- Ventricular tachyarrhythmia (VT)
HRT is a non-invasive tool for prediction complications like arrhythmias and sudden cardiac death in patients with heart failure with reduced ejection fraction.
Finally, we recommend further trials to evaluate whether ICD implantation could be inserted in patients with HFrEF with baseline HRT score 0/1 before starting sacubitril / valsartan to avoid complications like VT and sudden death.