Abstract 17889: Angiotensin-Neprelysin Inhibition is Superior to ACE Inhibition in Advanced Chronic Heart Failure
Introduction: Although angiotensin-neprilysin inhibition (ARNI) was shown to be superior to ACE inhibition (ACEI) in general heart failure population, data on patients with advanced chronic heart failure are lacking.
Hypothesis: We sought to evaluate the safety and efficacy of ARNI in patients with advanced chronic heart failure.
Methods: In a prospective single-center randomised study 55 patients with advanced chronic heart failure (NYHA III) were randomly allocated in a 1:1 ratio to continue with the optimal medical therapy (ACEI group) or to recieve ARNI instead or ACE (ARNI group). Patients were followed for 3 months; blood biochemical analysis, transthoracic echocardiography and ergospirometry were performed at baseline and at the end of follow-up.
Results: At baseline ARNI group (N=28) and ACEI group (N=27) did not differ significantly regarding gender (male 70% in ARNI group vs. 77% in ACEI group;P=0.54), age (55 years vs. 56 years;P=0.67), heart failure etiology (ischemic 45% vs. 35%;P=0.41), diabetes (26% vs. 15%;P=0.32), serum potassium (4.8±0.3 mmol/L vs. 4.6±0.7 mmol/L;P=0.19), creatinine (89±28 μmol/L vs. 98±23 μmol/L;P=0.20), NT-proBNP (2335±1983 pg/mL vs. 2897±1907 pg/mL), left ventricular ejection fraction (LVEF) (26±5% vs. 25±7%;P=0.63) and exercise capacity as measured by VO2max (15.7±2.7 mL/kg/min vs. 14.3±3.7 mL/kg/min). At 3 months ARNI group in comparisson to ACEI group displayed significantly improved LVEF (32±6% vs. 27±8%;P=0.02), NT-pro-BNP (1542±1591 pg/mL vs. 2833±1724 pg/mL;P=0.01) and showed a trend to improved exercise capacity (17.3±1.8 mL/kg/min vs. 14.6±2.6 mL/kg/min;P=0.10). Similar rates of symptomatic hypotension (11% vs. 15%;P=0.69) were observed in both groups and no inter-group differences were found regarding serum potassium (4.8±0.4 mmol/L vs. 4.7±0.6 mmol/L;P=0.65).
Conclusions: ARNI appears to be safe and efficient in patients with advanced chronic heart failure. Larger trials are needed to confirm these preliminary data and to establish potential survival benefit of ARNI in this patient cohort.
Author Disclosures: G. Poglajen: None. M. Jaklic: None. V. Androcec: None. G. Zemljic: None. S. Frljak: None. A. Cerar: None. R. Okrajek: None. M. ebetjen: None. B. Vrtovec: None.
- © 2016 by American Heart Association, Inc.