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Reverse Cardiac Remodeling and ARNI Therapy

  • CLINICAL HEART 4 FAILURE (T.E. MEYER, SECTION EDITOR)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review reverse cardiac remodeling and guideline-directed medical and device therapy (GDMT) within the context of recent data on combined angiotensin receptor/neprilysin inhibitor (ARNI) therapy.

Recent Findings

Preliminary data suggested that ARNI therapy led to significant reversal of deleterious cardiac remodeling. More definitive data regarding impact of ARNI therapy on remodeling parameters are now available from two prospective trials, PROVE-HF (Prospective Study of Biomarkers, Symptom Improvement, and Ventricular Remodeling During Sacubitril/Valsartan Therapy for Heart Failure) and EVALUATE-HF (Study of Effects of Sacubitril/Valsartan vs. Enalapril on Aortic Stiffness in Patients With Mild to Moderate HF With Reduced Ejection Fraction). Both studies demonstrated marked improvements in biomarker and echocardiographic parameters of reverse cardiac remodeling in patients with heart failure with reduced ejection fraction (HFrEF).

Summary

Much of the observed clinical benefit of sacubitril/valsartan therapy in patients with HFrEF is likely related to significant reverse cardiac remodeling. Ongoing trials will assess the role for ARNI therapy in patients with heart failure with preserved ejection fraction (HFpEF) and in the post-myocardial infarction setting. Future studies should comprehensively assess predictors of response to ARNI therapy.

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  1. Massachusetts General Hospital, 55 Fruit Street Yawkey 5B, Boston, MA, 02114, USA

    Andrew Abboud & James L. Januzzi

  2. Harvard Medical School, Boston, MA, USA

    Andrew Abboud & James L. Januzzi

  3. Baim Institute for Clinical Research, Boston, MA, USA

    James L. Januzzi

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Dr. Januzzi is a Trustee of the American College of Cardiology; a Board member of Imbria Pharmaceuticals; has received grant support from Novartis Pharmaceuticals and Abbott Diagnostics and consulting income from Abbott, Janssen, Novartis, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Janssen, and Takeda. Dr. Abboud declares that he has no conflict of interest.

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Abboud, A., Januzzi, J.L. Reverse Cardiac Remodeling and ARNI Therapy. Curr Heart Fail Rep 18, 71–83 (2021). https://doi.org/10.1007/s11897-021-00501-6

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