الفهرس 
HEART FAILUREOnly 14 pages are availabe for public view
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Abstract
Structural alterations in cardiac structures in response to hemody¬namic and neurohormonal factors are the main drivers of heart failure progression. In the combination ARNI, molecular synergy may reverse or reduce left ventricular remodeling. Speckle-tracking echocardiography (STE) is an established echocardiographic modality with clinical applications in the diagnosis and prognosis of many cardiac diseases. The study was done to evaluate the possible impact of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) therapy on cardiac remodeling using echocardiographic parameters including 2D and 3D global longitudinal strain (GLS) in heart failure patients with reduced ejection fraction
A total of eighty heart failure patients were divided into two arms. The first arm included forty symptomatic patients started on ARNI and the second arm was forty symptomatic patients on an optimal dose of ACE-I or ARBs, receiving standard treatment of heart failure and who were followed up for six months. All patients underwent echocardiography to assess baseline values including indexed LV volumes, 2D STE and 3D STE before initiating ARNI therapy and after a 6 month follow up period.
Both groups had no significant differences at baseline regarding demographic data and baseline echocardiographic findings, After 6 months follow up period, significant reduction in LV indexed volumes in ARNI group compared to ACE-I/ ARB group (P <0.001), improvement in LVEF ARNI group compared to ACE-I/ ARB (P=0.011), 2D LV GLS ARNI compared to ACE-I/ ARB (P <0.001) and no improvement in LV mass index. Significant reduction in LAVi ARNI compared to ACE-I/ ARB (P= 0.013), significant reduction in E/A ARNI compared to E/A ACE-I/ ARB (P= 0.043) and no improvement in lateral E/e’.
The use of ARNI for HF patients with reduced LV systolic function, followed up for a mean duration of 6 months, induced LV reverse remodeling in those patients as observed in a significant improvement in LV performance seen in both 2D-3D volumetric echocardiographic parameters, improved LVEF and longitudinal LV systolic function represented in 2D and 3D GLS.
LIMITATIONS
Sample Size was rather small, follow up period was short (6 months), longer follow up period would have shown more improvement in terms of LVRR. The use of Cardiac biomarkers in following up of both groups would have enriched the progression and prediction of reverse remodeling. More objective analysis of patient’s clinical condition using Kansas City Cardiomyopathy Questionnaire (105) or 6 minutes walk test (106) alongside NYHA functional assessment.
CONCLUSION
T
he study demonstrates that the use of ARNI for HF patients with reduced LV systolic function, followed up for a mean duration of 6 months, not only improves the NYHA class in those patients but also yields a significant improvement in LV performance as seen in both 2D-3D volumetric echocardiographic parameters and longitudinal LV systolic function represented in 2D and 3D GLS. The use of ARNI, absence of diabetes and a lower baseline 3D-GLS have been shown to be independent predictors for the occurrence of LV reverse remodeling (LVRR). These results can help clarify the role of ARNI therapy in inducing reverse remodeling in HFrEF patient showing a clear superiority in comparison with HF therapy including ACEI or ARBs.
RECOMMENDATIONS
W
e suggest using ARNI as a first line therapy in patients with HFrEF as our study showed that it has a more beneficial role as regarding early induction of LVRR and more improvement in LVEF when compared to ACEi or ARB. Further investigational study about widening and implication of 2D and 3D GLS as an early predictor of LVRR as it showed to be a strong prognostic and follow up tool.