Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy
Abstract Aims To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13801 |
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| author | Leonid Maizels Yishay Wasserstrum Boris Fishman Amitai Segev David Ben‐Nun Anan Younis Dov Freimark Israel Mazin Avishay Grupper |
| author_facet | Leonid Maizels Yishay Wasserstrum Boris Fishman Amitai Segev David Ben‐Nun Anan Younis Dov Freimark Israel Mazin Avishay Grupper |
| author_sort | Leonid Maizels |
| collection | DOAJ |
| description | Abstract Aims To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and results The ARNI‐treated HFrEF patients followed at a single tertiary medical centre HF‐outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post‐ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non‐ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non‐ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non‐ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non‐ischaemic HF and no CRT. |
| format | Article |
| id | doaj-art-5d998070d9d34fee8c12e73aab323bae |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-5d998070d9d34fee8c12e73aab323bae2025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931682168810.1002/ehf2.13801Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapyLeonid Maizels0Yishay Wasserstrum1Boris Fishman2Amitai Segev3David Ben‐Nun4Anan Younis5Dov Freimark6Israel Mazin7Avishay Grupper8Division of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelThe Sackler School of Medicine Tel‐Aviv University Tel‐Aviv IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelDivision of Cardiology, Leviev Center of Cardiovascular medicine Sheba Medical Center in Tel‐HaShomer Sheba Rd. 2 Ramat‐Gan IsraelAbstract Aims To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and results The ARNI‐treated HFrEF patients followed at a single tertiary medical centre HF‐outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post‐ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non‐ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non‐ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non‐ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non‐ischaemic HF and no CRT.https://doi.org/10.1002/ehf2.13801Reverse remodellingARNILV functionLV dimensionsEarly treatment initiation |
| spellingShingle | Leonid Maizels Yishay Wasserstrum Boris Fishman Amitai Segev David Ben‐Nun Anan Younis Dov Freimark Israel Mazin Avishay Grupper Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy ESC Heart Failure Reverse remodelling ARNI LV function LV dimensions Early treatment initiation |
| title | Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy |
| title_full | Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy |
| title_fullStr | Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy |
| title_full_unstemmed | Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy |
| title_short | Characterization of heart failure patients with reverse left ventricular remodelling post‐angiotensin receptor blockers/neprilysin inhibitors therapy |
| title_sort | characterization of heart failure patients with reverse left ventricular remodelling post angiotensin receptor blockers neprilysin inhibitors therapy |
| topic | Reverse remodelling ARNI LV function LV dimensions Early treatment initiation |
| url | https://doi.org/10.1002/ehf2.13801 |
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