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Switching to ARNI improves LVEF in heart failure

10 Jan 2018

In patients with heart failure with reduced ejection fraction (HFrEF), switch of therapy from an angiotensin-converting enzyme inhibitor (ACEI) to the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan significantly improves left ventricular ejection fraction (LVEF) at 1 year. [Pandey AK, et al, AHA 2017, poster S3196]

The results, from 100 patients with HFrEF on optimal medical therapy, also showed greater improvements in LVEF in patients with dilated cardiomyopathy (n=32) compared with those with ischaemic cardiomyopathy (n=68). In patients with dilated cardiomyopathy, LVEF improved from 27.1 percent at baseline to 45 percent at 1 year after switching to sacubitril/valsartan (p<0.001). In patients with ischaemic cardiomyopathy, LVEF improved from 26 to 36.2 percent (p<0.001).

Numerical improvements in fractional shortening were also found at 1 year after switching to sacubitril/valsartan (from 17.3 percent to 23.4 percent for patients with dilated cardiomyopathy [p=0.16]; from 15 percent to 19 percent in patients with ischaemic cardiomyopathy [p=0.06]).

In the single-centre retrospective study conducted in Cambridge, Ontario, Canada, sacubitril/valsartan was up-titrated to the full dose (103/97 mg BID) in 70 percent of the patients. Twenty percent of the patients were on an intermediate dose (51/49 mg BID), while 10 percent were on a low dose (26/24 mg BID). The main deterrent to dosage up-titration was symptomatic hypotension.

Patients in the study were on maximally tolerated background therapy with ACEIs, beta-blockers and mineralocorticoid receptor antagonists for a minimum of 3 months before switching from ACEIs to sacubitril/valsartan. The ARNI was generally well tolerated over 1 year. Only two patients discontinued sacubitril/valsartan and resumed ACEIs within 1 month of switching, as a result of hypotension.

According to the researchers, these findings may explain the clinical benefits of sacubitril/valsartan observed in the PARADIGM-HF study, which did not report the ARNI’s effects on LVEF. They also noted that in previous studies, improvements in cardiac ejection fraction and fractional shortening were found to be correlated to reductions in morbidity and mortality.

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Most Read Articles
Jairia Dela Cruz, 05 Oct 2020
Drinking more than two cups of coffee per day may just be the intervention that prevents hundreds of thousands of liver disease‐related deaths globally, a study reports.
Pearl Toh, 21 Sep 2020
Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.
Roshini Claire Anthony, 12 Oct 2020

Insulin icodec, an in-development basal insulin analogue administered once weekly, was as effective as once-daily insulin glargine in patients with type 2 diabetes (T2D) insufficiently controlled with metformin with or without a DPP-4* inhibitor, according to a phase II trial presented at EASD 2020.

Stephen Padilla, Yesterday
Use of systemic corticosteroids does not reduce in-hospital mortality for patients with severe or critical coronavirus disease (COVID-19), which is in stark contrast to that observed in the RECOVERY clinical trial, according to a study in Wuhan, China.