LAUSR

Key Points Question Can neprilysin inhibition improve markers of cardiovascular structure and function in patients with pre–heart failure with preserved ejection fraction? Findings In this randomized clinical trial of 250 asymptomatic patients, sacubitril/valsartan vs valsartan was associated with a reduction in blood pressure, pulse pressure, and N-terminal pro-b-type natriuretic peptide; an increase in maximal left atrial volume index measured by cardiac magnetic resonance imaging despite lower filling pressures; less decline in kidney function; and fewer serious adverse cardiovascular events. Meaning These findings could reflect improved cardiac and vascular compliance or adverse cardiac remodeling, and more work is required to understand the long-term implications.