TY - JOUR
T1 - Clinical benefits of angiotensin receptor-Neprilysin inhibitor in adults with congenital heart disease
AU - Andi, Kartik
AU - Abozied, Omar
AU - Miranda, William R.
AU - Anderson, Jason H.
AU - Connolly, Heidi M.
AU - Jain, C. Charles
AU - Burchill, Luke J.
AU - Egbe, Alexander C.
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/9/15
Y1 - 2023/9/15
N2 - Background: There are limited data about the clinical benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in adults with congenital heart disease (CHD). The purpose of the study was to assess the clinical benefits (chamber function and heart failure indices) of ARNI in adults with CHD. Method: In this retrospective cohort study, we compared the temporal change in chamber function and heart failure indices between 35 patients that received ARNI for >6 months, and a propensity matched control group (n = 70) of patients that received angiotensin converting enzyme inhibitor or angiotensin-II receptor blocker (ACEI/ARB) within the same period. Results: Of the 35 patients in the ARNI group, 21 (60%) had systemic left ventricle (LV) while 14 (40%) had systemic right ventricle (RV). Compared to the ACEI/ARB group, the ARNI group had greater relative improvement in LV global longitudinal strain (GLS) (28% versus 11% increase from baseline, p < 0.001) and RV-GLS (11% versus 4% increase from baseline, p < 0.001), and greater relative improvement in New York Heart Association functional class (−14 versus −2% change from baseline, p = 0.006) and N-terminal pro-brain natriuretic peptide levels (−29% versus −13% change from baseline, p < 0.001). These results were consistent across different systemic ventricular morphologies. Conclusions: ARNI was associated with improvement in biventricular systolic function, functional status, and neurohormonal activation, suggesting prognostic benefit. These results provide a foundation for a randomized clinical trial to empirically test the prognostic benefits of ARNI in adults with CHD, as the next step towards evidence-based recommendations for heart failure management in this population.
AB - Background: There are limited data about the clinical benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in adults with congenital heart disease (CHD). The purpose of the study was to assess the clinical benefits (chamber function and heart failure indices) of ARNI in adults with CHD. Method: In this retrospective cohort study, we compared the temporal change in chamber function and heart failure indices between 35 patients that received ARNI for >6 months, and a propensity matched control group (n = 70) of patients that received angiotensin converting enzyme inhibitor or angiotensin-II receptor blocker (ACEI/ARB) within the same period. Results: Of the 35 patients in the ARNI group, 21 (60%) had systemic left ventricle (LV) while 14 (40%) had systemic right ventricle (RV). Compared to the ACEI/ARB group, the ARNI group had greater relative improvement in LV global longitudinal strain (GLS) (28% versus 11% increase from baseline, p < 0.001) and RV-GLS (11% versus 4% increase from baseline, p < 0.001), and greater relative improvement in New York Heart Association functional class (−14 versus −2% change from baseline, p = 0.006) and N-terminal pro-brain natriuretic peptide levels (−29% versus −13% change from baseline, p < 0.001). These results were consistent across different systemic ventricular morphologies. Conclusions: ARNI was associated with improvement in biventricular systolic function, functional status, and neurohormonal activation, suggesting prognostic benefit. These results provide a foundation for a randomized clinical trial to empirically test the prognostic benefits of ARNI in adults with CHD, as the next step towards evidence-based recommendations for heart failure management in this population.
KW - Cardiac remodeling
KW - Heart failure pathophysiology
KW - Heart failure therapy
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U2 - 10.1016/j.ijcard.2023.131152
DO - 10.1016/j.ijcard.2023.131152
M3 - Article
C2 - 37429446
AN - SCOPUS:85165939524
SN - 0167-5273
VL - 387
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 131152
ER -