Effect of angiotensin receptor neprilysin inhibitors on left atrial remodeling and prognosis in heart failure

Journal article


Sun, Yuxi, Song, Shuang, Zhang, Yanli, Mo, Wenqiong, Zhang, Xinxin, Wang, Ning, Xia, Yunlong, Tse, Gary and Liu, Ying 2021. Effect of angiotensin receptor neprilysin inhibitors on left atrial remodeling and prognosis in heart failure. ESC Heart Failure. 9 (1), pp. 667-675. https://doi.org/10.1002/ehf2.13691
AuthorsSun, Yuxi, Song, Shuang, Zhang, Yanli, Mo, Wenqiong, Zhang, Xinxin, Wang, Ning, Xia, Yunlong, Tse, Gary and Liu, Ying
Abstract

Aims
The angiotensin receptor–neprilysin inhibitor (ARNI), sacubitril/valsartan, confers additional protective effects compared with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) in terms of reversed left ventricular (LV) remodelling and improves the prognosis of patients with heart failure (HF). However, few studies have examined the effects of ARNI on the left atrium. Accordingly, this study compared the effects of ARNI and ACEI/ARB on left atrial (LA) remodelling in heart failure with reduced ejection fraction (HFrEF).

Methods and results
This was a single-centre retrospective study of patients with HFrEF hospitalized at the First Affiliated Hospital of Dalian Medical University between 26 February 2016 and 8 July 2020. Patients were classified into ARNI and ACEI/ARB groups and further subgroups based on the left atrial volume index (LAVI): mildly abnormal (29 mL/m2 ≤ LAVI < 34 mL/m2), moderately abnormal (34 mL/m2 ≤ LAVI < 40 mL/m2), and severely abnormal (LAVI ≥ 40 mL/m2). The primary endpoint was changes in LA parameters by echocardiography. The secondary endpoint was all-cause mortality. A total of 336 patients (mean age: 64.11 ± 12.86, 30.06% female) were included. Except those lost to follow-up, 274 HFrEF patients remained, with 144 cases in the ARNI group and 130 cases in the ACEI/ARB group. Greater reductions from baseline were seen with ARNI in LA diameter (LAD) (P = 0.013, t-test), superior and LA superior–inferior diameter (LASID) (P < 0.0001), LA transverse diameter (LATD) (P < 0.0001), LA volume (LAV) (P < 0.0001), LAVI (P < 0.0001), and LA sphericity index (LASI) (P < 0.0001). Over a mean follow-up of 19.40 months, 97 patients (67.3%) in the ARNI group and 29 patients (22.3%) in the ACEI/ARB group showed LA reverse remodelling (LARR). Kaplan–Meier analysis showed significantly lower overall mortality in the ARNI group compared with the ACEI/ARB group (P = 0.048, log-rank test). The mildly abnormal LAVI group of ARNI patients showed a reduction in mortality compared with ACEI/ARB patients (P = 0.044). However, no significant difference was observed for the moderately abnormal (P = 0.571) or severely abnormal LAVI groups (P = 0.609), suggesting that early initiation of ARNI was associated with a better prognosis.

Conclusions
In this proof-of-concept study, ARNI use showed greater effects on LARR and was associated with a better prognosis compared with ACEI/ARB use in HFrEF. Early initiation of ARNI in the HF disease process may produce greater benefit, but this needs to be confirmed in future studies.

KeywordsSacubitril/valsartan; Left atrium remodelling; Heart failure; Mortality
Year2021
JournalESC Heart Failure
Journal citation9 (1), pp. 667-675
PublisherWiley
ISSN2055-5822
Digital Object Identifier (DOI)https://doi.org/10.1002/ehf2.13691
Official URLhttps://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.13691
FunderNational Natural Science Foundation of China
Publication dates
Online14 Nov 2021
Publication process dates
Accepted25 Oct 2021
Deposited17 Feb 2022
Publisher's version
License
Output statusPublished
Permalink -

https://repository.canterbury.ac.uk/item/8zqvw/effect-of-angiotensin-receptor-neprilysin-inhibitors-on-left-atrial-remodeling-and-prognosis-in-heart-failure

  • 9
    total views
  • 3
    total downloads
  • 3
    views this month
  • 1
    downloads this month

Export as

Related outputs

Editorial: Risk stratification strategies for cardiac rhythm abnormalities
Tse, Gary, Zhang, Nan, Song, Wenhua, Letsas, Konstantinos P., Ngarmukos, Tachapong, Jeevaratnam, Kamalan and Liu, Tong 2022. Editorial: Risk stratification strategies for cardiac rhythm abnormalities. Frontiers in Cardiovascular Medicine. 9, p. 887461. https://doi.org/10.3389/fcvm.2022.887461
C-reactive protein and atrial fibrillation: Insights from epidemiological and Mendelian randomization studies.
Li, Xintao, Peng, Shi, Wu, Xiaoyu, Guan, Bo, Tse, Gary, Chen, Songwen, Zhou, Genqing, Wei, Yong, Gong, Chao, Lu, Xiaofeng, Xu, Juan, Wu, Shouling and Liu, Shaowen 2022. C-reactive protein and atrial fibrillation: Insights from epidemiological and Mendelian randomization studies. Nutrition, metabolism, and cardiovascular diseases : NMCD. https://doi.org/S0939-4753(22)00130-2
Pathogenesis and management of Brugada Syndrome: Recent advances and protocol for umbrella reviews of meta-analyses in major arrhythmic events risk stratification
Aziz, H., Zarzecki, Michał P, Garcia-Zamora, Sebastian, Kim, Min Seo, Bijak, Piotr, Tse, Gary, Won, Hong-Hee and Matusik, P. 2022. Pathogenesis and management of Brugada Syndrome: Recent advances and protocol for umbrella reviews of meta-analyses in major arrhythmic events risk stratification. Journal of Clinical Medicine. 11 (7). https://doi.org/jcm11071912
Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study.
Chou, O., Zhou, Jiandong, Lee, Teddy Tai Loy, Kot, Thompson, Lee, Sharen, Wai, Abraham Ka Chung, Wong, Wing Tak, Zhang, Qingpeng, Cheng, Shuk Han, Liu, Tong, Vassiliou, Vassilios S, Cheung, Bernard Man Yung and Tse, Gary 2022. Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study. Clinical research in cardiology : official journal of the German Cardiac Society. https://doi.org/10.1007/s00392-022-02007-0
Liver immune-related adverse effects of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors: A propensity score matched study with competing risk analyses
Zhou, J, Chau, Y-L A, Yoo, J W, Lee, S, Ng, K, Dee, E C, Liu, T, Wai, A K C, Zhang, Q and Tse, G 2022. Liver immune-related adverse effects of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors: A propensity score matched study with competing risk analyses. Clinical Oncology (Royal College of Radiologists (Great Britain)). https://doi.org/10.1016/j.clon.2022.03.006
EPR22-112: Risk of prostate cancer for Metformin versus Sulphonylurea monotherapy in Type 2 Diabetes Mellitus: A propensity score-matched retrospective cohort study
Lee, Yan Hiu Athena, Zhou, Jiandong, Hui, Jeremy Man Ho, Liu, Xuejin, Lee, Teddy Tai Loy, Hui, Kyle, Wai, Abraham Ka Chung, Wong, Wing Tak, Liu, Tong, Ng, Kenrich, Lee, Sharen, Dee, Edward Christopher, Chan, Jeffrey Shi Kai, Zhang, Qingpeng and Tse, Gary 2022. EPR22-112: Risk of prostate cancer for Metformin versus Sulphonylurea monotherapy in Type 2 Diabetes Mellitus: A propensity score-matched retrospective cohort study. Journal of the National Comprehensive Cancer Network. 20 (3.5), pp. EPR22-112. https://doi.org/10.6004/jnccn.2021.7189
Predictive risk models for forecasting arrhythmic outcomes in Brugada syndrome: A focused review
Chung, Cheuk To, Bazoukis, George, Radford, Danny, Coakley-Youngs, Emma, Rajan, Rajesh, Matusik, Paweł T, Liu, Tong, Letsas, Konstantinos P, Lee, Sharen and Tse, Gary 2022. Predictive risk models for forecasting arrhythmic outcomes in Brugada syndrome: A focused review. Journal of Electrocardiology. 72, pp. 28-34. https://doi.org/10.1016/j.jelectrocard.2022.02.009
Right ventricular outflow tract endocardial unipolar substrate mapping: implications in risk stratification of Brugada syndrome
Letsas, Konstantinos P, Vlachos, Konstantinos, Efremidis, Michael, Dragasis, Stylianos, Korantzopoulos, Panagiotis, Tse, Gary, Liu, Tong, Bazoukis, George, Niarchou, Panagioula, Prappa, Efstathia, Sacher, Frederic, Hocini, Meleze and Baranchuk, Adrian 2022. Right ventricular outflow tract endocardial unipolar substrate mapping: implications in risk stratification of Brugada syndrome. Reviews in Cardiovascular Medicine. 23 (2), p. 44. https://doi.org/S1530-6550(22)00331-3
A novel three-dimensional and tissue Doppler echocardiographic index for diagnosing and prognosticating heart failure with preserved ejection fraction
Wang, Weiding, Mu, Guanyu, Liu, Changle, Xie, Juan, Zhang, Hao, Zhang, Xiaowei, Che, Jingjin, Tse, Gary, Liu, Tong, Li, Guangping and Fu, Huaying 2022. A novel three-dimensional and tissue Doppler echocardiographic index for diagnosing and prognosticating heart failure with preserved ejection fraction. Frontiers in Cardiovascular Medicine. 9, p. 822314. https://doi.org/10.3389/fcvm.2022.822314
Type 2 innate immunity drives distinct neonatal immune profile conducive for heart regeneration.
Chen, Francis M, Tse, Joyce Ky, Jin, Leigang, Chook, Chui Yiu Bamboo, Leung, Fung Ping, Tse, Gary, Woo, Connie W, Xu, Aimin, Chawla, Ajay, Tian, Xiao Yu, Chan, Ting-Fung and Wong, Wing Tak 2022. Type 2 innate immunity drives distinct neonatal immune profile conducive for heart regeneration. Theranostics. 12 (3), pp. 1161-1172. https://doi.org/10.7150/thno.67515
Effectiveness of sacubitril-valsartan in patients with cancer therapy-related cardiac dysfunction (CTRCD): a systematic review of clinical and preclinical studies
Duraes, Andre R, Bitar, Yasmin S, Neto, Mansueto G, Mesquita, Evandro T, Chan, Jeffrey S, Tse, Gary, Liu, Tong, Boochi, Edimar A, Biondi-Zoccai, Giuseppe and Roever, Leonardo 2022. Effectiveness of sacubitril-valsartan in patients with cancer therapy-related cardiac dysfunction (CTRCD): a systematic review of clinical and preclinical studies. Minerva Medica. https://doi.org/10.23736/S0026-4806.22.08029-6
Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study.
Zhou, Jiandong, Zhang, Guoming, Chang, Carlin, Chou, O., Lee, Sharen, Leung, Keith Sai Kit, Wong, Wing Tak, Liu, Tong, Wai, Abraham Ka Chung, Cheng, Shuk Han, Zhang, Qingpeng and Tse, Gary 2022. Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study. Acta Diabetologica. https://doi.org/10.1007/s00592-021-01841-4
The value of IGF-1 and IGFBP-1 in patients with heart failure with reduced, mid-range, and preserved ejection fraction
Guo, Shaohua, Gong, Mengqi, Tse, Gary, Li, Guangping, Chen, Kang-Yin and Liu, Tong 2022. The value of IGF-1 and IGFBP-1 in patients with heart failure with reduced, mid-range, and preserved ejection fraction. Frontiers in Cardiovascular Medicine. 8, p. 772105. https://doi.org/10.3389/fcvm.2021.772105
Cardiac abnormalities after induction of endoplasmic reticulum stress are associated with mitochondrial dysfunction and connexin43 expression
He, Jinli, Gong, Mengqi, Wang, Zaojia, Liu, Daiqi, Xie, Bingxin, Luo, C., Li, Guangping, Tse, Gary and Liu, T. 2021. Cardiac abnormalities after induction of endoplasmic reticulum stress are associated with mitochondrial dysfunction and connexin43 expression. Clinical and Experimental Pharmacology and Physiology. https://doi.org/10.1111/1440-1681.13541
Hip fractures risks in edoxaban versus warfarin users: A propensity score-matched population-based cohort study with competing risk analyses
Zhou, Jiandong, Lee, Sharen, Liu, Xuejin, Iltaf Satti, Danish, Tai Loy Lee, Teddy, Hou In Chou, Oscar, Chang, Carlin, Roever, Leonardo, Tak Wong, Wing, Ka Chung Wai, Abraham, Liu, Tong, Zhang, Qingpeng and Tse, Gary 2021. Hip fractures risks in edoxaban versus warfarin users: A propensity score-matched population-based cohort study with competing risk analyses. Bone. 156, p. 116303. https://doi.org/S8756-3282(21)00469-5
Fragmented QRS is independently predictive of long-term adverse clinical outcomes in Asian patients hospitalized for heart failure: A retrospective cohort study
Chan, Jeffrey Shi Kai, Zhou, Jiandong, Lee, Sharen, Li, Andrew, Tan, Martin, Leung, Keith Sai Kit, Jeevaratnam, Kamalan, Liu, Tong, Roever, Leonardo, Liu, Ying, Tse, Gary and Zhang, Qingpeng 2021. Fragmented QRS is independently predictive of long-term adverse clinical outcomes in Asian patients hospitalized for heart failure: A retrospective cohort study. Frontiers in Cardiovascular Medicine. 8, p. 738417. https://doi.org/10.3389/fcvm.2021.738417
Atrial cardiomyopathy: An emerging cause of the embolic stroke of undetermined source
Ning, Yuye, Tse, G., Luo, Guogang and Li, Guoliang 2021. Atrial cardiomyopathy: An emerging cause of the embolic stroke of undetermined source. Frontiers in Cardiovascular Medicine. 8, p. 674612. https://doi.org/10.3389/fcvm.2021.674612
Heart failure with midrange ejection fraction: Prior left ventricular ejection fraction and prognosis
Zhang, Xinxin, Sun, Yuxi, Zhang, Yanli, Chen, Feifei, Zhang, Shuyuan, He, Hongyan, Song, Shuang, Tse, Gary and Liu, Ying 2021. Heart failure with midrange ejection fraction: Prior left ventricular ejection fraction and prognosis. Frontiers in Cardiovascular Medicine. 8, p. 697221. https://doi.org/10.3389/fcvm.2021.697221
Ventricular tachyarrhythmia risk in paediatric/young vs. adult Brugada Syndrome patients: A territory-wide study
Lee, Sharen, Wong, Wing Tak, Wong, Ian Chi Kei, Mak, Chloe, Mok, Ngai Shing, Liu, Tong and Tse, Gary 2021. Ventricular tachyarrhythmia risk in paediatric/young vs. adult Brugada Syndrome patients: A territory-wide study. Frontiers in Cardiovascular Medicine. 8, p. 671666. https://doi.org/10.3389/fcvm.2021.671666
The association between blood pressure variability and hip or vertebral fracture risk: A population-based study
Zhou, Jiandong, Li, Helen, Chang, Carlin, Wu, William K.K., Wang, Xiansong, Liu, Tong, Cheung, Bernard Man Yung, Zhang, Qingpeng, Lee, Sharen and Tse, Gary 2021. The association between blood pressure variability and hip or vertebral fracture risk: A population-based study. Bone. 150, p. 1160115. https://doi.org/10.1016/j.bone.2021.116015