Introduction: Angiotensin receptor-neprilysin inhibitors have been introduced in the last few years as a new class of drugs for the treatment of heart failure (HF) patients. Its benefits have been proven in randomized control trials in HF patients, mostly with reduced ejection fraction. Recent studies reveal new indications and information about benefit in patients after myocardial infarction by reducing myocardial fibrosis and remodeling. Treatment of HF in patients after heart transplantation is challenging with limitations in therapeutic possibilities. (1, 2) We present a case report of a heart transplant patient with significant clinical and echocardiographic improvement after sacubitril/valsartan introduction.

Case report: 56-year-old patient, with a history of heart transplantation in 2014 due to ischemic cardiomyopathy, was hospitalized for HF. Dyspnea and reduced exercise tolerance had been worsening 2 months prior to hospital admission. Echocardiography showed moderately reduced left ventricular systolic function (EF 32%), diffuse hypocontractility (GLPSavg -4%) and pulmonary artery hypertension (RSVP 65 mmHg), which did not differ much from earlier examinations. In order to improve cardiac function, sacubitril/valsartan was added into treatment. 3 months later the patient was feeling much better with significantly improved physical activity tolerance. Echocardiography exam showed improvement of left ventricular systolic function (EF 41%) and longitudinal myocardial deformation (GLPSavg -7.5%) with reduction of pulmonary artery hypertension (RSVP 50 mmHg).

Conclusion: To our knowledge and available literature, sacubitril/valsartan has not been used in treatment of HF patients after heart transplantation. Significant clinical and echocardiographic improvement in short period of time after introduction of sacubitril/valsartan presents curiosity. Undoubtedly, such information requires further investigation.