Impact of Angiotensin Receptor-Neprilysin Inhibitor Therapy on Cardiac Remodeling in Patients with Heart Failure and Reduced Ejection Fraction

Abstract Background Structural alterations in cardiac structures in response to hemodynamic and neurohormonal factors are the main drivers of heart failure progression. In the combination ARNI, molecular synergy may reverse or reduce left ventricular remodeling. Speckle-tracking echocardiography (STE) is an established echocardiographic modality with clinical applications in the diagnosis and prognosis of many cardiac diseases. Aim of the Study The study was done to evaluate the possible impact of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) therapy on cardiac remodeling using echocardiographic parameters including 2D and 3D global longitudinal strain (GLS) in heart failure patients with reduced ejection fraction Patients and Methods This prospective observational study included a total of eighty heart failure patients were divided into two arms. The first arm included forty symptomatic patients started on ARNI and the second arm was forty symptomatic patients on an optimal dose of ACE-I or ARBs, receiving standard treatment of heart failure and who were followed up for six months. All patients underwent echocardiography to assess baseline values including indexed LV volumes, 2D STE and 3D STE before initiating ARNI therapy and after a 6 month follow up period. Results Both groups had no significant differences at baseline regarding demographic data and baseline echocardiographic findings, After 6 months follow up period, significant reduction in LV indexed volumes in ARNI group compared to ACE-I/ ARB group (P < 0.001), improvement in LVEF ARNI group compared to ACE-I/ ARB (P = 0.011), 2D LV GLS ARNI compared to ACE-I/ ARB (P < 0.001) and no improvement in LV mass index. Significant reduction in LAVi ARNI compared to ACE-I/ ARB (P = 0.013), significant reduction in E/A ARNI compared to E/A ACE-I/ ARB (P = 0.043) and no improvement in lateral E/e’. Conclusion The use of ARNI for HF patients with reduced LV systolic function, followed up for a mean duration of 6 months, induced LV reverse remodeling in those patients as observed in a significant improvement in LV performance seen in both 2D-3D volumetric echocardiographic parameters, improved LVEF and longitudinal LV systolic function represented in 2D and 3D GLS.