https://orcid.org/0000-0002-0502-4058
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Abstract
Objective
To compare the effects of Angiotensin Receptor-Neprilysin inhibitor (ARNI) on the clinical symptoms, echocardiographic parameters, and outcomes (cardiovascular death and hospitalization) in heart failure with reduced ejection fraction (HFrEF) and heart failure with mid-range ejection fraction (HFmrEF) patients with coronary heart disease and chronic kidney disease.
Method
A retrospective observational study was conducted from January 2018 to May 2019, with a follow-up period of 95.4 ± 57.8 days (8 months). Data from 127 patients were included.
Results
A statistically significant increase of 68.8% was observed in left ventricular ejection fraction (LVEF) in HFrEF patients compared to that in HFmrEF patients, with an increase of 27.2% at 8 months of follow-up. Sacubitril/valsartan significantly reduced left ventricular end-systolic volumes (LVESV) in HFrEF patients unlike in HFmrEF patients. The decrease in LVESV was 28.8% in HFrEF patients and 17.1% in HFmrEF patients. A significant reduction in the prevalence of severe secondary mitral regurgitation (EROA > 0.4 cm2) was observed in HFrEF compared to that in HFmrEF patients with the use of sacubitril/valsartan. A reduction of 15.6% was observed in HFrEF patients, whereas a reduction of 7.1% was observed in HFmrEF patients. Improvement in functional classification (NYHA) was observed during follow-up. The prevalence of (NYHA III) reduced from 50% to 15.7% in HFrEF patients, whereas a reduction from 21.1% to 8.8% was observed in HFmrEF patients. There was a significant reduction in NT-proBNP in HFrEF patients compared to that in HFmrEF patients. A reduction of 52% was observed in HFrEF patients, whereas a reduction of 28.7% was observed in HFmrEF pateints. Sacubitril/valsartan reduced primary endpoint events in both groups. The prevalence of HF-related hospitalization was higher in HFrEF than in HFmrEF patients: 12.1% vs 7.5%, respectively. The prevalence of CV death in HFrEF vs HFmrEF patients was 3.7% vs 0.5%, respectively. Cardiovascular (CV) death was higher in patients with atrial fibrillation in both groups.
Conclusion
Sacubitril/valsartan significantly improved morphofunctional remodeling parameters and clinical symptoms in HFrEF patients than in HFmrEF patients.
Transparency
Declaration of interest
The authors declare no conflict of interest to declare. The funding authorities did not influence data collection or the manuscript.
Author contributions
First authors: DMR and ZL, and two authors contribute this research equally in conceptualization, data curation, methodology, formal analysis, writing original draft, investigation, visualization, and writing a review, XC investigation, writing a review, and editing, DH investigation, writing review and editing, WH investigation, visualization, review and editing, JS investigation, methodology, writing review and editing. All authors read and approved the final manuscript; DS participated in supervision, conceptualization, editing, funding acquisition.
Acknowledgements
We extend our sincere gratitude to all the members of the staff within the cardiology department and the nephrology department and research committee at the first affiliated hospital of Zhengzhou University. Our sincere gratitude thanks to all our funding sources, Henan University Funding Program (no.19HASTIT002), Central China Funding Plan (no.204200510017), and Henan Health and Family Planning Commission Funding “51282” Program for their support.
Ethical statement
Since the study was a retrospective observational study, data were all fully anonymized before being accessed. The study followed the principles of the Declaration of Helsinki [WHO, 2001].