Role of Angiotensin Receptor-Neprilysin Inhibitors (ARNI) in Patients with Heart Failure with Reduced Ejection Fraction

Abstract

- Objective: The aim of the research is to study the effect of Angiotensin Receptor-Neprilysin Inhibitors in HFrEF heart failure patients compared to classical treatment in terms of symptoms control, echocardiograhic changes in heart structure, laboratory improvement, hospitalization rates and the incidence of arrhythmias..

- Materials and Methods: A Prospective Cohort Study, conducted on patients attending the cardiac clinic at Damascus University Hospitals (Al-Mowasat University Hospital, Al-Assad University Hospital), who were presented with symptoms of heart failure, during the period between 1/March/2020 and 1/December/2020.

- Results: The research included 48 patients (30 males, 18 females) diagnosed with HFrEF, who themselves formed the control and control groups in two separate phases during the study. We found that ARNI had a better effect than classical treatment of heart failure through: reduction in dyspnea score to mean (1.44±0.6) with a statistically significant difference from classical treatment (P-value<0.001), improvement of left ventricular diameters: LVIDd, LVIDs (P-value=0.004) ), EF (P-value<0.0001), improved cardiac spherical index (P-value=0.027), and reduced NT-proBNP value to a mean of 399 pg/l with a statistically significant difference from classical treatment (P-value= 0.001). The use of ARNI also reduced the incidence of hospitalization in patients better than classical treatment (P-value<0.0001), and also reduced the incidence of arrhythmias (P-value<0.001), while the use of ARNI did not have a distinct role in reducing the severity of mitral valve regurgitation.

- Conclusions: ARNI as a line of treatment for HFrEF patients outperforms classical therapy (ACEI) in terms of its ability to control symptoms, improve dyspnea, improve cardiac function, reduce remodeling rates, and improve NT-proBNP values. It also outperformed classical treatment in its ability to reduce hospitalization rates, and reduce the incidence of cardiac arrhythmias in patients.