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ARNI Versus Perindopril for Remodeling in HFrEF. A Cohort Study.
Noor Muhammad Azlan Shah Bin Atan1, Mohd Firdaus Bin Hadi1, Victoria Wen Yeng Teoh1
1Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Journal of Cardiovascular Pharmacology and Therapeutics
|August 28, 2023
Summary
Angiotensin receptor-neprilysin inhibitor (ARNI) and perindopril both improved ejection fraction in heart failure patients. ARNI showed a stronger remodeling effect, significantly reducing left ventricular end-systolic volume.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Ventricular remodeling is a detrimental process in heart failure with reduced ejection fraction (HFrEF).
- Angiotensin-converting enzyme inhibitors and sacubitril/valsartan have demonstrated remodeling reversal in observational studies.
- Head-to-head comparisons of these treatments are limited.
Purpose of the Study:
- To compare the ventricular remodeling effects of angiotensin receptor-neprilysin inhibitor (ARNI) versus perindopril in HFrEF patients.
- To evaluate changes in left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), and end-systolic volume (LVESV).
Main Methods:
- A cohort study of HFrEF patients (EF < 40%) treated between 2017-2020.
- Patients received either ARNI or perindopril, with no prior renin-angiotensin-aldosterone system inhibitor use in the ARNI group.
- Echocardiography assessed LVEF, LVEDV, and LVESV at baseline and 6-18 months post-treatment.
Main Results:
- Both ARNI and perindopril significantly improved LVEF (11.5% and 11.8% increase, respectively) after 9 months.
- ARNI led to greater reductions in LVEDV (8.4 mL vs. 3.2 mL) and LVESV (17.9 mL vs. 10.8 mL).
- The reduction in LVESV with ARNI was statistically significant (P = .007).
Conclusions:
- Both ARNI and perindopril effectively improve LVEF in HFrEF patients within 9 months.
- ARNI demonstrates a potentially stronger ventricular remodeling effect, particularly in reducing left ventricular volumes.
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