الفهرس 
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Abstract
The assessment of patients with HF with reduced ejection fraction HFrEF with 2D STE has been increasingly used for an objective evaluation of LV systolic function and the early detection of improvement with prognostic significance in various pathological entities.
So, this study aimed to prove the efficacy of STE in early detection of left ventricular systolic function improvement in patients with HF with reduced ejection fraction HFrEF who are taking SV.
This study included 51 patients with HFrEF who started sacubtril/valsartan. from 51 patients included, 6 patients were dropped out, with percent of drop:11.7 % due to the following causes: one patient died, 2 patients had severe hyperkalemia K > 5.5 mg/dl, 2 patients had severe hypotension and one patient had acute kidney injury, the net number was 45 patients.
The current study patients had mean age of 55.6±9.3 years old ranged from 35 to 74 years old, 75.6% were males and 24.4% were females. They had mean BSA of 1.92±0.2. 35.6% of them were ex-smokers, 33.3% were current smokers and 31.1% were non-smokers. 73.3% of patients were on ACE-I or ARBs before S/V. Most of patients (73.3%) started S/V treatment on dose 24 /26 and 26.7% of patients started on 49 /51. Most of patients (64.4%) had NYHA class III, 11.2% class II and 24.4% had class IV.
In this study, 30 patients (66.7%) had hypertension, 20 patients (44.4%) had diabetes mellitus, 18 (40%) patients had dyslipidemia and 14 patients (31.1%) had CKD.
In this study, 27 patients (60%) had ischemic CMP, and 18 patients (40%) had Non- ischemic CMP.
Most of the patients included in our study at the start had normal renal profile. Mean serum urea was 39.4±11.7 mg\dl, mean serum creatinine was 1.16±0.43 mg\dl, mean serum sodium level was 137.6±4 mmol\l and mean serum potassium level of 4.03±0.43 mmol\l.
100
The majority of patients (73.3%) started sacubitril/valsartan at the lowest dose (24/26 mg twice daily) with the rest (26.7%) started at 49/51 mg twice daily. No patients received a starting dose of 97/103 mg. At three months, many patients received higher doses of SV