Fewer ventricular arrhythmias with angiotensin-neprilysin vs angiotensin inhibition in HF
Effects of angiotensin-neprilysin inhibition as compared to angiotensin inhibition on ventricular arrhythmias in reduced ejection fraction patients under continuous remote monitoring of implantable defibrillator devices.Literature - de Diego C, González-Torres L, Núñez JM, et al. - Heart Rhythm 2017; published online ahead of print
- ARNI was associated with an improvement in NYHA functional class (P<0.0002), a decrease of pro-BNP levels from 1971±1530 pg/ml to 1172±955 pg/ml (P<0.01), an increase of LVEF from 30.4±4 to 35.1±8% (P<0.01), and a decrease in LV diastolic diameter of 61±5 mm vs. 58±6 mm (P<0.01).
- ARNI therapy was also associated with a significant increase in potassium levels (from 4.4±0.5 to 4.7±0.5 mEq/l; P <0.03), significant decreases in HR and BP, while GFR was not significantly changed.
- Compared to angiotensin inhibition alone, patients on ARNI had significantly fewer ICD shocks at 9 months (99.2% survival free from appropriate ICD shocks with ARNI vs. 93.3% with angiotensin inhibition alone; P<0.02).
- Sustained VT was significantly decreased with ARNI as compared to angiotensin inhibition, from 6.7 % to 0.8% at 9 months (P <0.02). A Kaplan-Meier curve also showed significant reduction of NSVT with ARNI as compared to angiotensin inhibition.
- ARNI was associated with a significant decrease of NSVT episodes/patient as compared to angiotensin inhibition (15 ±1.7 vs. 5.4±0.5; P <0.002). The number of patients with ≥1 episode of NSVT were significantly reduced from 71 to 45 with ARNI (P<0.0001).
- Compared to angiotensin inhibition, ARNI was associated with a significant reduction of the PVC burden at 9 months (P <0.0003), driven by an increase of biventricular pacing percentage from 95±6 % to 98.8±1.3 % (P <0.02).
- Based on repeated measures analyses, patients with ventricular arrhythmia ICD events had significantly higher levels of pro-BNP. Particularly in this patient subgroup, ARNI significantly decreased pro-BNP levels.
In HFrEF patients with an ICD under remote control, angiotensin-neprilysin inhibition as compared to angiotensin inhibition alone decreased ventricular arrhythmias, leading to a reduction of appropriate ICD shocks.