This site is intended for healthcare professionals

Sign in
Go to /sign-in page

You can view 5 more pages before signing in

Angiotensin receptor neprilysin inhibition (ARNI)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Sacubitril/valsartan (S/V) is an angiotensin receptor blocker/neprilysin inhibitor (ARNI) and has been shown to improve mortality and HF hospitalization inpatients with HF with reduced ejection fraction (HFrEF) (1,2)

Sacubitril and cardiac remodeling:

  • in PROVE-HF (ProspectiveStudy of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entres to Therapy for Heart Failure;NCT02887183) study (3) demonstrated that S/V had favorable effects on measures of cardiac reverse remodeling
    • including increase in left ventricular (LV) ejection fraction (LVEF) over a 12-month period, as well as simultaneous improvements inother measures such as left atrial (LA) volume index(LAVI)
    • changes in measures of cardiac reverse remodeling were shown to strongly associate with reductions in N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations; because it is an inert fragment, NT-proBNP is only a marker of HF, not a mediator

    • a prespecified substudy of PROVE-HF showed a rapid significant rise in atrial natriuretic peptide (ANP) was associated with greater improvements in LVEF and reduction of LAVI, measures of cardiac remodeling (4)
      • the study results suggest a role of ANP as a mechanism of benefit by sacubitril/valsartan

Reference:

  • Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J 2016;37:2129-200.
  • Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart FailureSociety of America. J Am Coll Cardiol 2017;70: 776-803
  • Januzzi JL Jr., Prescott MF, Butler J, et al. Association of change in N-terminal pro-B-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction. JAMA 2019;322:1-11.
  • Murphy SP, Prescott MF, Camachoet A et al.Early increase ANP after ARNI initiation associated with reverse cardiac remodeling in HFrEF JACC Heart Fail. 2020, doi.org/10.1016/j.jchf.2020.09.013

Related pages

Create an account to add page annotations

Create a free account

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.