Impact of angiotensin-receptor neprilysin inhibitor on reverse cardiac remodeling in patients with heart failure with reduced ejection fraction (hfref)

Type of funding sources: None.

Cardiac remodeling is a detrimental consequence of heart failure. The angiotensin-receptor neprilysin inhibitor (ARNI) sacubitril/valsartan has been shown to reverse cardiac remodeling and to improve systolic function in observational studies. There is a lack of local data regarding the effects of ARNI on cardiac remodeling in Asian populations. To determine the impact of ARNI on reverse cardiac remodeling. 

The study was conducted at our University Medical Centre as a retrospective cohort study. Data was collected for the period from January 2017 until December 2020. Patients were included if they fulfilled the following criteria: i) age >18 years, ii) recent diagnosis of HFrEF (EF < 40%), iii) baseline Echocardiography was performed not more than 18 months prior to initiation of ARNI or Perindopril, iv)  Echocardiography reassessment was performed not earlier than 6 months and not later than 18 months post initiation of ARNI or Perindopril, v) the HFrEF must have been diagnosed not more than 1 year prior to  initiation of therapy. Echocardiographic parameters analyzed included Left Ventricular Ejection Fraction (LVEF), Left Ventricular End Diastolic Volume (LVEDV), and Left Ventricular End Systolic Volume (LVESV). 40 patients with complete echocardiographic sets treated with ARNI were identified. Another 40 patients treated with Perindopril and matching clinical characteristics were identified accordingly. Patients receiving ARNI recorded an increase in the LVEF from 24.9% ± 8.0% (mean ± standard deviation) to 36.4% ±12.3% (p <0.001) and improvement in LVESV by 17% from the baseline (p = 0.003). Patients treated with Perindopril demonstrated a similar improvement in the LVEF from 28.7% ± 7.4% to 40.5%±15.9% (p <0.001) with improvement in LVESV by 12.7% from the baseline (p = 0.093). The changes in LVEDV were less significant in both group (5.8% volume reduction in ARNI group and 2.6% in Perindopril group; p value 0.224 and 0.584 respectively). Treatment of recently diagnosed HFrEF patients with both ARNI and Perindopril resulted in significant improvement in the LVEF within 18 months after initiation of therapy. 

The results of the study must be interpreted with caution as for the small sample size, the retrospective character of the study, and the relatively short follow-up period.