Angiotensin receptor neprilysin inhibitor (ARNI) in right ventricular failure and preserved LV ejection fraction: A systematic review and meta-analysis.
- 1Department of Cardiovascular Medicine, Cardiovascular Research Institute, Mazandaran University of Medical Sciences, Sari, Iran.
- 2Cardiovascular Research Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Abstract
Background
Right ventricular (RV) failure with preserved left ventricular (LV) ejection fraction (LVEF ≥50%) is a distinct clinical entity often associated with pulmonary hypertension (PH), chronic lung diseases, or congenital heart defects, leading to significant morbidity and mortality. Angiotensin receptor neprilysin inhibitors (ARNI), such as sacubitril/valsartan, have demonstrated efficacy in left-sided heart failure, but their role in isolated RV failure remains understudied.Methods
A PRISMA-compliant search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar was conducted from 2010 to 2025 for RCTs and prospective cohorts assessing ARNI in patients with RV failure and preserved LVEF. Inclusion: Adults with RV dysfunction (e.g., TAPSE <17 mm or RV S' <9.5 cm/s) and LVEF ≥50%; ARNI vs. standard care or pre-treatment; reporting RV parameters, sPAP, NT-proBNP, 6MWD, or NYHA class.Results
Three studies (1 RCT, 2 prospective cohorts; n=120 patients) were included. ARNI improved TAPSE (WMD 1.2 mm, 95% CI 0.7-1.7; p<0.001; I²=0%), RV S' (WMD 0.5 cm/s, 95% CI 0.2-0.8; P=0.002; I²=0%), and reduced sPAP (WMD -7.5 mmHg, 95% CI -10.2 to -4.8; p<0.001; I²=15%). NT-proBNP decreased (WMD -1200 pg/mL, 95% CI -1700 to -700; p<0.001; I²=0%). 6MWD increased (WMD 30 m, 95% CI 10-50; P=0.003; I²=0%). NYHA class improved (RR 1.65 for ≥1 class improvement, 95% CI 1.15-2.37; P=0.007; I²=0%).Conclusion
ARNI enhances RV function, reduces pulmonary pressures, and improves functional status in RV failure with preserved LVEF.
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BibTeX
@article{safari2026angiotensin,
title = {{Angiotensin receptor neprilysin inhibitor (ARNI) in right ventricular failure and preserved LV ejection fraction: A systematic review and meta-analysis.}},
author = {Mohsen Safari and Zeinab Safari},
journal = {Caspian journal of internal medicine},
year = {2026},
month = sep,
doi = {10.22088/cjim.17.3.511},
url = {https://europepmc.org/article/MED/42924105},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Angiotensin receptor neprilysin inhibitor (ARNI) in right ventricular failure and preserved LV ejection fraction: A systematic review and meta-analysis.
AU - Mohsen Safari
AU - Zeinab Safari
PY - 2026
DA - 2026/09/01
JO - Caspian journal of internal medicine
DO - 10.22088/cjim.17.3.511
UR - https://europepmc.org/article/MED/42924105
AB - Background Right ventricular (RV) failure with preserved left ventricular (LV) ejection fraction (LVEF ≥50%) is a distinct clinical entity often associated with pulmonary hypertension (PH), chronic lung diseases, or congenital heart defects, leading to significant morbidity and mortality. Angiotensin receptor neprilysin inhibitors (ARNI), such as sacubitril/valsartan, have demonstrated efficacy in left-sided heart failure, but their role in isolated RV failure remains understudied.Methods A PRISMA-compliant search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar was conducted from 2010 to 2025 for RCTs and prospective cohorts assessing ARNI in patients with RV failure and preserved LVEF. Inclusion: Adults with RV dysfunction (e.g., TAPSE <17 mm or RV S' <9.5 cm/s) and LVEF ≥50%; ARNI vs. standard care or pre-treatment; reporting RV parameters, sPAP, NT-proBNP, 6MWD, or NYHA class.Results Three studies (1 RCT, 2 prospective cohorts; n=120 patients) were included. ARNI improved TAPSE (WMD 1.2 mm, 95% CI 0.7-1.7; p<0.001; I²=0%), RV S' (WMD 0.5 cm/s, 95% CI 0.2-0.8; P=0.002; I²=0%), and reduced sPAP (WMD -7.5 mmHg, 95% CI -10.2 to -4.8; p<0.001; I²=15%). NT-proBNP decreased (WMD -1200 pg/mL, 95% CI -1700 to -700; p<0.001; I²=0%). 6MWD increased (WMD 30 m, 95% CI 10-50; P=0.003; I²=0%). NYHA class improved (RR 1.65 for ≥1 class improvement, 95% CI 1.15-2.37; P=0.007; I²=0%).Conclusion ARNI enhances RV function, reduces pulmonary pressures, and improves functional status in RV failure with preserved LVEF.
SN - 2008-6164
SN - 2008-6172
ER -