Effect Of Sacubitril/valsartan On Ventricular Remodeling In Patients After Acute Anterior Myocardial Infarction

Objective:This retrospective study aimed to comparatively assess the effects of early application of sacubitril/valsartan(ARNI)versus ACEI/ARB on left ventricular remodeling and progression of heart failure in individuals with acute anterior wall myocardial infarction.Subjects and methods:The present trial was carried out in the Department of Cardiology,the Second Hospital of Dalian Medical University,and examined 168 AAMI cases between January 1,2019 and August 30,2022.AAMI cases were included and assigned to the ARNI(n=97)and ACEI/ARB(n=71)groups according to the different drugs used.Clinical data were collected for each patient at baseline and at post-discharge follow-up,including general data(gender,age,systolic and diastolic blood pressure,heart rate,height,weight)and previously diagnosed conditions(hypertension,diabetes mellitus,smoking history,etc.),coronary artery disease,drug titration,completion of emergency reperfusion therapy,myocardial biomarkers(c Tn I and CK-MB),BNP,K~+,serum creatinine,EGFRs,lipid profile,liver biochemical indexes,and blood routine indexes;cardiac ultrasound data at baseline and follow-up visits at 0-3 months and 6-12 months,as well as left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),relative wall thickness(RWT),left atrial internal diameter(LA),left ventricular ejection fraction(LVEF),E/e’,and E/A.Major adverse cardiac events(MACEs)were recorded throughout the follow-up period.The primary endpoint was ventricular chamber enlargement>10%and LVEF decline>10%.Secondary endpoints included all-cause death,malignant arrhythmia,out-or in-patient heart failure,and ventricular aneurysm.Results:1.Basic data:A total of 168 eligible patients were retrospectively analyzed.Including 139 males(82.7%)and 29 females(17.3%),97 patients with hypertension(57.7%),61 patients with diabetes(36.3%),100 patients with smoking(59.5%),105 cases with drug dose titration(62.5%),including 57 cases in the ARNI group(58.8%),48 cases in the ACEI/ARB group(67.6%);129 patients with completed emergency reperfusion therapy(76.8%),71 patients in the ARNI group(73.2%),58 patients in the ACEI/ARB group(81.7%),18 patients had coronary artery disease,13 patients in the ARNI group(13.4%),and 5 patients in the ACEI/ARB group(7.0%).Compared with ACEI/ARB group,age(P=0.021),BNP level(P=0.014),BMI(P=0.012)in ARNI group were statistically significant.2.Cardiac ultrasound data:At baseline,LVEF was significantly lower in the ARNI group in comparison with the ACEI/ARB group(50.4±9.0%versus53.7±9.4%,P=0.003),which indicated that at baseline,patients in the ARNI group had poorer heart function and more severe disease than those of the AECI/ARB group.At 0-3 months of follow-up,there was no obvious difference in LVEF between the ARNI group and the ACIE/ARB group(P>0.05),making clear that the cardiac function of the ARNI group was significantly improved from baseline and was the same as that of the ACEI/ARB group.during 6-12 months of follow-up,LVEDD was significantly reduced in the ARNI group compared with the ACEI/ARB group(P<0.001).Meanwhile,RWT was significantly elevated in the ARNI group compared with the ACEI/ARB group(P=0.026).3.Subgroup analysis:In the target patients of drug titration,patients who completed emergency reperfusion therapy and patients with LVEF≥50%,it was also found that ARNI group was significantly better than ACEI/ARB group in improving LVEDD and RWT(P<0.05).4.Compared with the risk of a composite cardiac event during follow-up,there was no statistically significant difference between the ARNI and ACEI/ARB groups for the primary event(p>0.05),while a significant reduction in the secondary endpoint event was seen in the ARNI group compared with the ACEI/ARB group(23.9%vs 5.2%,p<0.001),After adjusting for covariates such as age,grouping,drug dose titration,completion of emergency reperfusion therapy,Killip grading,arrhythmia,diabetes,BMI,and heart rate,smoking history,it was found that ARNI patients with AAMI had a lower risk of ventricular remodeling than ACEI/ARB patients.HR=0.409(95%CI:0.205-0.819).Conclusion:1.Early application of ARNI can increase LVEF and improve ventricular function,and it is significantly superior to ACEI/ARB in long-term improvement of LVEDD and RWT,indicating that ARNI has markedly advantages in maintaining normal cardiac geometry and reversing ventricular remodeling.2.Subgroup analysis showed that the cardioprotective effect of ARNI was more obvious than that of ACEI/ARB in patients who achieved the target dose,in patients who completed emergency reperfusion therapy,and in patients with LVEF≥50%.3.Moreover,this regimen markedly decreased the risk of adverse cardiac events and prolonged the survival time of patients.These findings provide insights into drug selection for preventing ventricular remodeling in acute anterior myocardial infarction cases.4.Sacubitril/valsartan(ARNI)should be applied early in patients after acute anterior myocardial infarction,thus replacing ACEI/ARB for the purpose of delaying,or even reversing,ventricular remodeling,delaying the progression of heart failure,and improving patient prognosis.