Atrial Natriuretic Peptide and Treatment With Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction

Murphy, Sean; Prescott, Margaret F.; Camacho, Alexander; Iyer, Seethalakshmi; Maisel, Alan S.; Felker, G. Michael; Butler, Javed; Piña, Ileana L.; Ibrahim, Nasrien E.; Abbas, Cheryl; Burnett, John C.; Solomon, Scott D.; Januzzi, James L.

doi:10.1016/j.jchf.2020.09.013

Cited by 54 publications

(60 citation statements)

References 25 publications

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“…When comparing the primary composite endpoint in the pre‐specified subgroups, it is indicated that patients with cardiac ejection fraction no more than 40% and aged no more than 60 years tend to benefit more from ARNI as compared with ACEI/ARB. Clinical trials have proved that the benefits of ARNI are most clearly evident in patients with LVEF below normal 10–14 . These subgroup data should be taken with caution and warrant large sample validation but might indicate preference for clinical treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trials have proved that the benefits of ARNI are most clearly evident in patients with LVEF below normal. 10 , 11 , 12 , 13 , 14 These subgroup data should be taken with caution and warrant large sample validation but might indicate preference for clinical treatments. Interestingly, it is also shown that female AMI patients utilizing ARNI exhibited a better long‐term outcome as compared with ACEI users.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Additionally, a number of studies have confirmed that in HF patients with reduced ejection fraction, sacubitril/valsartan can reduce N‐terminal B‐type natriuretic peptide levels, increase left ventricular ejection fraction (LVEF), and reverse ventricular remodelling, exerting more clinical and symptomatic benefits as compared to ACEI/ARB. 10 , 11 , 12 , 13 , 14 Although increasing evidence support the use of ARNI therapy instead of ACEI or ARB for patients with HF, the evidence for AMI patients is still lacking. The Prospective ARNI vs.…”

Section: Introductionmentioning

confidence: 99%

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ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction

et al. 2021

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Aims This study aimed to compare the efficacy of angiotensin receptor‐neprilysin inhibitor (ARNI) therapy with angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy for cardiovascular outcomes in patients with acute myocardial infarction (AMI). Methods and results Data were collected from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and December 2020. A total of 7556 AMI patients were screened for eligibility. Propensity score matching based on age, sex, blood pressure, kidney function, baseline left ventricular ejection fraction (LVEF), and cardiovascular medication were conducted, resulting in 291 patients with AMI being assigned to ARNI, ACEI, and ARB group, respectively. Patients receiving ARNI had significantly lower rates of the composite cardiovascular outcome than ACEI {hazard ratio [HR] 0.51, [95% confidence interval (CI), 0.27–0.95], P = 0.02}, and ARB users [HR 0.47, (95%CI, 0.24–0.90), P = 0.02]. Patients receiving ARNI showed lower rates of cardiovascular death than ACEI [HR 0.37, (95%CI, 0.18–0.79), P = 0.01] and ARB users [HR 0.41, (95%CI, 0.18–0.95), P = 0.04]. Subgroup analysis indicated that patients with LVEF no more than 40% tend to benefit more from ARNI as compared with ACEI [HR 0.30, (95%CI, 0.11–0.86), P = 0.01] or ARB [HR 0.21, (95%CI, 0.04–1.1), P = 0.05]. Patients aged no more than 60 years exhibited reduced composite endpoints [HR for ARNI vs. ARB: 0.11, (95%CI, 0.03–0.46), P = 0.002]. Conclusions In patients with AMI, ARNI was superior to ACEI/ARB in reducing the long‐term adverse cardiovascular outcomes. Subgroup analysis further indicates that ARNI is more likely to benefit patients with LVEF less than 40% and aged less than 60 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction

et al. 2021

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“…To date, the only other treatment that has been shown to decrease any profibrotic biomarker are MRAs (N-terminal propeptide of procollagen type III). Finally, a pre-specified secondary analysis of the PROVE-HF study showed that the initiation of treatment with sacubitril/valsartan produced a rapid (before 14 days) and significant increase in atrial natriuretic peptide (ANP) correlated with a subsequent increase in urinary cGMP ( 50 ).…”

Section: Cardiac Remodeling and Neprilysin Inhibitionmentioning

confidence: 99%

Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review

Pascual-Figal

Bayés‐Genís

Beltrán-Troncoso

et al. 2021

Front. Cardiovasc. Med.

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Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.

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“…The degree of recovery is correlated with improvements in atrial mechanical function and reduced LAV. Interestingly, a rapid and significant rise in ANP levels is associated with greater gains in LVEF after therapy, suggesting that the LA may be an indicator of responsiveness to HF therapy (106). Reverse remodeling has been observed even in patients with HFpEF, as demonstrated by a reduction in LAV and BNP levels during therapy with carvedilol, angiotensin receptor, and neprilysin inhibitor (3, 107).…”

Section: Left Atrial Strain As a Therapeutic Targetmentioning

confidence: 99%

The Central Role of Left Atrium in Heart Failure

Carpenito

Fanti

Mega

et al. 2021

Front. Cardiovasc. Med.

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In past cardiovascular medicine, the attention to the left ventricle-identified as the only indicator and determinant of healthy or unhealthy cardiac conditions- has systematically hidden the role of the left atrium (LA). The recent advances in cardiovascular imaging have provided a better understanding of LA anatomy, physiology, and pathology, making us realize that this functional structure is far from being an innocent spectator. We now know that the LA's mechanical and neuro-hormonal properties play a relevant part in several cardiovascular diseases, including atrial fibrillation, ischemic heart disease, valvular heart disease, and heart failure. The present review aims to describe the role of LA in the specific setting of heart failure. We provide currently available information on LA structure and function and summarize its role as a determinant of symptoms, prognosis, and potential therapeutic target in heart failure patients.

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Atrial Natriuretic Peptide and Treatment With Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction

Cited by 54 publications

References 25 publications

ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction

ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction

Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review

The Central Role of Left Atrium in Heart Failure

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