Comparison of Saocubitril/valsartaN Versus Enalapril on Effect on ntpRo-bnp in Patients Stabilized From an Acute Heart Failure Episode.

Key Inclusion Criteria:

1. Possess the capacity to provide written informed consent which must be obtained before
any assessment is performed.

2. Currently hospitalized for ADHF. Patients with a diagnosis of acute heart failure had
to have symptoms and signs of fluid overload (i.e. jugular venous distention, edema or
rales on auscultation or pulmonary congestion on chest x-ray) at time of
hospitalization.

3. Eligible patients will be randomized no earlier than 24 hours and up to ten days after
presentation while still hospitalized as long as meet the following definition of
stable status:

- SBP ≥100mm Hg for the preceding 6 hours prior to randomization; no symptomatic
hypotension

- No increase (intensification) in i.v. diuretic dose within last 6 hours prior to
randomization

- No i.v. inotropic drugs for 24 hours prior to randomization

- No i.v. vasodilators including nitrates within last 6 hours prior to
randomization

4. LVEF ≤40% within the past 6 months (including current hospitalization) using
echocardiography, multi gated acquisition scan (MUGA), CT scanning, MRI or ventricular
angiography, provided no subsequent study documented an EF of >40%.

5. Elevated NT-proBNP ≥ 1600pg/mL OR BNP ≥400 pg/mL during current hospitalization.

Key Exclusion Criteria:

1. Currently taking sacubitril/valsartan tablets or any use within the past 30 days.

2. Enrollment in any other clinical trial involving an investigational agent or
investigational device.

3. History of hypersensitivity, known or suspected contraindications, or intolerance to
any of the study drugs, including ACEIs, ARBs, or Sacubitril (NEP inhibitor).

4. Patients with a known history of angioedema related to previous ACE inhibitor or ARB
therapy.

5. Requirement of treatment with both ACE inhibitor and ARB.

6. eGFR < 30 ml/min/1.73 m2 as measured by the simplified Modification of Diet in Renal
Disease (MDRD) formula at screening.

7. Serum potassium > 5.2 mEq/L at screening.

8. Known hepatic impairment (as evidenced by total bilirubin > 3 mg/dL, or increased
ammonia levels, if performed), or history of cirrhosis with evidence of portal
hypertension such as varices

9. Acute coronary syndrome, stroke, transient ischemic attack; cardiac, carotid or other
major CV surgery; percutaneous coronary intervention (PCI) or carotid angioplasty,
within one month prior to Visit 1.

10. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
female after conception and until the termination of gestation, confirmed by a
positive hCG laboratory test.

11. Women of child-bearing potential, defined as all women physiologically capable of
becoming pregnant, including women whose career, lifestyle, or sexual orientation
precludes intercourse with a male partner and women whose partners have been
sterilized by vasectomy or other means, UNLESS they are using two birth control
methods.