AimsAngiotensin receptor-neprilysin inhibitors (ARNis) acts an ARB and neprilysin inhibitor. Diabetes mellitus significantly increases the risk of cardiovascular disease and heart failure (HF). Therefore, we evaluated the effects and mechanisms of ARNi in HF with reduced ejection fraction (HFrEF) Methods and resultsMale C57BL/6J mice were injected with streptozotocin to produce diabetic mice. After myocardial reperfusion injury, diabetic mice were randomized to treatment for 4 weeks with LCZ696 (60 mg/kg), valsartan (30 mg/kg), or no treatment (n = 26-28 in each group). Cardiac function was assessed by a pressure-volume Millar catheter. The ratios of heart weight to body weight in the valsartan (P = 0.02) and LCZ696 (P = 0.005) groups were significantly less than that in the control group. Treatment with LCZ696 improved LVEF (43 ± 3.4%) with a significantly reduction of atrial natriuretic peptide mRNA in the left ventricle compared with that in the control group (29 ± 3.2%) (P = 0.006). The fibrotic area in the LCZ696 group was significantly suppressed compared with those in the control (P = 0.003) and valsartan (P = 0.04) groups. Moreover, the mRNA level of transforming growth factor-(TGF-) in the left ventricle was suppressed in the LCZ696 group compared with that in the control (P = 0.002) group.

Highlights The effect of LCZ696 (Sacubitril/valsartan) against cardiorenal syndrome is proposed. LCZ696 more improved CKD related heart failure than valsartan therapy alone. LCZ696 attenuated CKD related cardiac hypertrophy and fibrosis and aortic fibrosis. Effects of LCZ696 for heart are mediated by anti-inflammation and oxidative stress. LCZ696 also improved indicators of mitochondrial mass/function. AbstractBackground: Chronic kidney disease (CKD) is associated with cardiac hypertrophy, fibrosis and

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Optimal KBI can be achieved with MBO and proximal dilatation by an optimally sized balloon.