Effectiveness of Angiotensin Receptor Blocker/Neprilysin Inhibitor in Heart Failure with Reduced Ejection Fraction Patients at Somdejphrajaotaksin Maharaj Hospital

Abstract

Background and objectives: Due to patients with HFrEF had increased tendency in Somdejphrajaotaksin Maharaj Hospital annually, and they were started ARNI treatment in HF clinic. Many abroad studies shown benefits of ARNI for improve symptoms in patients with HFrEF by many mechanisms (increase urine sodium excretion, vasodilatation, anti-proliferative effect and reverse cardiac remodeling). So, this study aimed to study the effectiveness and adverse events of ARNI in HFrEF patients at HF clinic in Thai practice, primary outcome is improvement of left ventricular ejection fraction (LVEF). Secondary outcomes are improvements of cardiac size (LA size, LVIDd)  and New York Heart Association Functional Classification (NYHA).

Methods: The quasiexperiment one group pre-posttest study was conducted to collect data (anthropometric data, NYHA, underlying diseases, guideline-directed therapy drugs, duration to change ARNI, vital signs, serum potassium, serum creatinine, eGFR, echocardiographic parameters) from patients with HFrEF who attended in HF clinic at Somdejphrajaotaksin Maharaj Hospital from September 1, 2020 to August 31, 2021 for a period of 12 months.

Result: A total of 35 patients (26 male, 74.3 %), mean age 66.20 ±0.44 years, were included. Mean LVEF (baseline, 3^rd ARNI mo, 12^th ARNI mo) were 29.81 ±9.48 %, 48.05 ±9.80 %, 49.58 ±9.32 %, respectively. From baseline to 3^rd ARNI mo, baseline to 12^th ARNI mo, and from 3^rd to 12^th ARNI mo, mean LVEF change increased 18.25 % (p<0.001), 19.77 % (p<0.001) and 1.52 % (p=0.011) respectively. The cardiac size (LA size, LVIDd). Mean LA size (baseline, 3^rd ARNI mo,12^th ARNI mo) were 4.28 ±0.71 cm, 4.05 ±0.62 cm, 3.98 ±0.60 cm, respectively. From baseline to 3^rd ARNI mo, baseline to 12^th ARNI mo, and from 3^rd to 12^th ARNI mo, mean LA size change decreased 0.22 cm (p<0.001), 0.30 cm (p<0.001) and 0.08 cm (p=0.016), respectively. Mean LVIDd (baseline, 3^rd ARNI mo, 12^th ARNI mo) were 5.72 ±0.66 cm, 5.52 ±0.61 cm, 5.35 ±0.58 cm, respectively. From baseline to 3^rd ARNI mo, baseline to 12^th ARNI mo, and from 3^rd to 12^th ARNI mo, mean LVIDd change decreased 0.21 cm (p<0.001), 0.37 cm (p<0.001) and 0.16 cm (p<0.001), respectively. Median NYHA (baseline, 3^rd ARNI mo, and 12^th ARNI mo) were 3.00 ±1.00, 2.00 ±1.00, 2.00 ±1.00, respectively. From baseline to 3^rd ARNI mo, baseline to 12^th ARNI mo, and from 3^rd to 12^th ARNI mo, NYHA change were 2.00 ±1.00 (p<0.001), 2.00 ±1.00 (p<0.001), 2.00 ±1.00 (p=0.317) respectively. There were no statistically significant difference in serum potassium level, serum creatinine and eGFR during treatment period and no hypotension was reported in volunteers.

Conclusion: In patients with HFrEF treated with sacubitril-valsartan (ARNI), The cardiac function (LVEF), cardiac size (LA size, LVIDd) and NYHA were improved significantly from the 3^rd month until 12^th month of ARNI treatment. No adverse event was reported.