The following is a summary of “Pressure-flow responses to exercise in heart failure treated with angiotensin receptor neprilysin inhibitor,” published in the January 2024 issue of Cardiology by Yamaguchi et al.
In this study, the researchers sought to explore the impact of angiotensin receptor neprilysin inhibitor (ARNI) on cardiac function, mainly focusing on pulmonary circulation in heart failure patients, which remains underexplored. Recent studies have highlighted the potential of abnormal mean pulmonary artery pressure (mPAP) and cardiac output (CO) responses as valuable indicators of the disease state.
Their investigation involved 39 heart failure patients who underwent a 6-minute walk (6 MW) test, and subsequent echocardiographic parameters were measured and compared with baseline values. The primary hypothesis was that ARNI treatment would enhance the pulmonary pressure-flow relationship, as evaluated through 6 MW stress echocardiography. The study included individualized ARNI doses, and follow-up assessments were conducted after one year. Results demonstrated a significant reduction in left ventricular (LV) volume (160.7 ± 49.6 ml vs 136.0 ± 54.3 ml, P < 0.001) and a marked improvement in LV ejection fraction (37.6 ± 11.3% vs 44.9 ± 11.5%, P < 0.001). Among the 31 patients who underwent 6 MW stress echocardiographic studies at baseline and one year later, there was a notable increase in the 6 MW distance after treatment (380 m vs 430 m, P = 0.003).
Importantly, the ΔmPAP/ΔCO during 6 MW stress decreased with treatment (6.9 mmHg/L/min vs 2.8 mmHg/L/min, P = 0.002). The left atrial volume index was identified as having an association with the response group receiving ARNI treatment for pulmonary circulation. In conclusion, the initiation of ARNI was linked to improvements in left ventricular size and ejection fraction. Furthermore, the 6 MW distance increased, and the ΔmPAP/ΔCO improved to within the normal range with ARNI treatment, highlighting its potential benefits in addressing cardiac function and pulmonary circulation in heart failure patients.
Source: sciencedirect.com/science/article/abs/pii/S0167527324001190