4.6 Article

Clinical benefits of angiotensin receptor-Neprilysin inhibitor in adults with congenital heart disease

Journal

INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 387, Issue -, Pages -

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2023.131152

Keywords

Heart failure therapy; Heart failure pathophysiology; Cardiac remodeling

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This retrospective cohort study compared the clinical benefits of angiotensin receptor-neprilysin inhibitor (ARNI) with angiotensin converting enzyme inhibitor or angiotensin-II receptor blocker (ACEI/ARB) in adults with congenital heart disease (CHD). The results showed that ARNI was associated with improved biventricular systolic function, functional status, and neurohormonal activation. These findings provide a foundation for further research on the prognostic benefits of ARNI in this population.
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 consis-tent 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.

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