Cardiac Reverse Remodeling and Clinical Outcomes Following Angiotensin Receptor‐Neprilysin Inhibitor Therapy in Heart Failure With Reduced Ejection Fraction
- 1Seoul National University Hospital
- 2Seoul National University College of Medicine
- 3Seoul National University Bundang Hospital
Abstract
Background Cardiac reverse remodeling and associated clinical outcomes following angiotensin receptor‐neprilysin inhibitor (ARNI) therapy in patients with heart failure (HF) with reduced ejection fraction (EF) remain unclear. We investigated differences in 1‐year echocardiographic response after ARNI therapy and predictors of clinical outcomes. Methods This study involved patients with HF with reduced EF and ARNI therapy for more than 6 months, using data from a 2‐center registry. Echocardiographic data were analyzed at baseline and 1 year after ARNI initiation. Responders were defined as patients with a ≥30% reduction in left ventricular end‐systolic volume at 1 year; all others were nonresponders. The primary outcome was cardiovascular death, and secondary outcomes were hospitalization for HF and all‐cause death. Time‐by‐group interactions in echocardiographic parameters were evaluated using linear mixed‐effects models. Results Among 1002 patients (mean age: 64.2±13.7 years; 70.8% men), 451 (45.0%) were responders and 551 (55.0%) were nonresponders. Responders had a lower baseline left ventricular EF but higher left ventricular EF at 1 year (27.0% [95% CI, 22.0–33.0] and 48.0% [95% CI, 42.0–55.0]). Both groups showed improvements in diastolic parameters, with more pronounced changes in responders. In multivariable analysis, nonresponders had a significantly higher risk of cardiovascular death, hospitalization for HF, and all‐cause death (all P <0.001). Male sex and a higher baseline left ventricular EF were independent predictors of nonresponse, whereas systolic blood pressure ≥110 mm Hg and atrial fibrillation were associated with better outcomes. Conclusions Cardiac reverse remodeling after ARNI therapy varies among patients with HF with reduced EF. Positive responders to ARNI therapy at 1 year experienced more favorable clinical outcomes.
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BibTeX
@article{bae2026cardiac,
title = {{Cardiac Reverse Remodeling and Clinical Outcomes Following Angiotensin Receptor‐Neprilysin Inhibitor Therapy in Heart Failure With Reduced Ejection Fraction}},
author = {Nan Young Bae and Soongu Kwak and Chan Soon Park and Jiesuck Park and Hong‐Mi Choi and Yeonyee E. Yoon and Yong‐Jin Kim and Jun‐Bean Park and Seung‐Pyo Lee and In‐Chang Hwang and Hyung‐Kwan Kim},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.051306},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.051306},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cardiac Reverse Remodeling and Clinical Outcomes Following Angiotensin Receptor‐Neprilysin Inhibitor Therapy in Heart Failure With Reduced Ejection Fraction
AU - Nan Young Bae
AU - Soongu Kwak
AU - Chan Soon Park
AU - Jiesuck Park
AU - Hong‐Mi Choi
AU - Yeonyee E. Yoon
AU - Yong‐Jin Kim
AU - Jun‐Bean Park
AU - Seung‐Pyo Lee
AU - In‐Chang Hwang
AU - Hyung‐Kwan Kim
PY - 2026
DA - 2026/10/20
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.051306
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.051306
AB - Background Cardiac reverse remodeling and associated clinical outcomes following angiotensin receptor‐neprilysin inhibitor (ARNI) therapy in patients with heart failure (HF) with reduced ejection fraction (EF) remain unclear. We investigated differences in 1‐year echocardiographic response after ARNI therapy and predictors of clinical outcomes. Methods This study involved patients with HF with reduced EF and ARNI therapy for more than 6 months, using data from a 2‐center registry. Echocardiographic data were analyzed at baseline and 1 year after ARNI initiation. Responders were defined as patients with a ≥30% reduction in left ventricular end‐systolic volume at 1 year; all others were nonresponders. The primary outcome was cardiovascular death, and secondary outcomes were hospitalization for HF and all‐cause death. Time‐by‐group interactions in echocardiographic parameters were evaluated using linear mixed‐effects models. Results Among 1002 patients (mean age: 64.2±13.7 years; 70.8% men), 451 (45.0%) were responders and 551 (55.0%) were nonresponders. Responders had a lower baseline left ventricular EF but higher left ventricular EF at 1 year (27.0% [95% CI, 22.0–33.0] and 48.0% [95% CI, 42.0–55.0]). Both groups showed improvements in diastolic parameters, with more pronounced changes in responders. In multivariable analysis, nonresponders had a significantly higher risk of cardiovascular death, hospitalization for HF, and all‐cause death (all P <0.001). Male sex and a higher baseline left ventricular EF were independent predictors of nonresponse, whereas systolic blood pressure ≥110 mm Hg and atrial fibrillation were associated with better outcomes. Conclusions Cardiac reverse remodeling after ARNI therapy varies among patients with HF with reduced EF. Positive responders to ARNI therapy at 1 year experienced more favorable clinical outcomes.
SN - 2047-9980
ER -