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Background Sacubitril/valsartan (SV) promotes reverse cardiac remodelling in patients with heart failure and reduced ejection fraction (HFrEF); however, not all patients respond to therapy. Baseline left atrial strain (LAS) and any changes associated with SV therapy may be a prognosticator of response to therapy in HFrEF patients.Methods Consecutive HFrEF patients on stable guideline-directed medical therapy prior to commencing SV that was up-titrated to maximal dose were retrospectively identified over a five-year period at a single centre. LAS was calculated using speckle-tracking echocardiography. Spearman’s rank correlation coefficients ( ρ) were used to investigate the relationships between therapy-associated changes (Δ) in LAS (reservoir [LASr], conduit [LAScd], contraction [LASct]) and LVEF or NT-proBNP. The prognostic value of baseline LAS was then investigated by correlating it to ΔLVEF and ΔNT-proBNP.Results Included were 138 patients (81% male, 60 ± 12 years), with a mean ΔLVEF, ΔNT-proBNP, ΔLASr, ΔLAScd, and ΔLASct of 5.9 ± 12.9%, -713.0 ± 1766.3 pg/ml, 1.5 ± 10.0%, -0.5 ± 7.8%, and -1.3 ± 7.9%, respectively. ΔLASr and ΔLAScd were significantly correlated with ΔLVEF ( ρ = 0.281, P = 0.001 and ρ = -0.1784, P = 0.038) (figure 1A). Furthermore, baseline values of LASr and LAScd were significantly correlated with ΔNT-proBNP (ρ = 0.207, P = 0.028 and ρ = -0.224, P = 0.017) (figure 1B).Conclusion Therapy-associated changes in LASr and LAScd correlated with those in LVEF. Moreover, baseline LASr and LAScd were predictive of improvement in NT-proBNP after 3 months of SV therapy.Abstract 3 Figure 1(A) correlations of ΔLAS with ΔLVEF (red) and ΔNT pro-BNP (green), (B) correlation of baseline LAS with ΔLVEF (red) and ΔNT pro-BNP (green)