Early myocardial injury is common during anthracycline therapy, and sacubitril-valsartan showed clear benefit in limiting this decline in cardiac strain parameters. Published in Circulation, the SARAH trial evaluated 114 adults with elevated high-sensitivity cardiac troponin I during chemotherapy, of whom 90% were women and 80.7% had breast cancer.

Participants received sacubitril-valsartan or placebo for six months, targeting a dose of 97/103 mg twice daily. The primary endpoint occurred in 7% of patients on sacubitril-valsartan and 25% on placebo. Treatment improved global longitudinal strain by 2.5%, while placebo showed a 7.6% decline. Changes in cardiac troponin I and N-terminal pro-B-type natriuretic peptide were similar between groups, but sacubitril-valsartan preserved myocardial function more effectively.

Hypotension with systolic pressure below 100 mm Hg occurred in 8 patients on sacubitril-valsartan and 1 patient on placebo. The overall results suggest a possible preventive role for sacubitril-valsartan in anthracycline-induced cardiotoxicity and support the need for larger confirmatory studies.