Impact of the angiotensin receptor-neprilysin inhibitor on chronic heart failure due to adult congenital heart disease: A systematic review and meta-analysis

JHLT Open Pub Date : 2025-02-18 DOI:10.1016/j.jhlto.2025.100230

Bibhuti B. Das MD, MBA, MHA , Shriprasad Deshpande MD , Lazaros Nikolaidis MD , Jianli Niu MD, PhD

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引用次数: 0

Abstract

Background

Heart failure (HF) is a significant complication in adults with congenital heart disease (ACHD), often requiring advanced therapeutic strategies. Angiotensin receptor-neprilysin inhibitors (ARNIs) have emerged as a promising alternative to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HF management. However, their safety and efficacy in ACHD-related HF remain unclear. This systematic review and meta-analysis aim to evaluate the impact of ARNIs on functional and safety outcomes in this unique patient population.

Methods

We conducted a systematic review and meta-analysis of published studies assessing the use of ARNIs in ACHD patients with HF, comparing them to ACEIs/ARBs. The primary outcome was the change in New York Heart Association (NYHA) functional class (FC). Additionally, we assessed the safety profile of ARNIs in this population.

Results

Our meta-analysis included 14 studies encompassing 305 patients. Substituting ACEIs/ARBs with ARNIs significantly improved the NYHA functional class (log odds ratio [log OR] 0.67, 95% CI 0.15–1.19; p = 0.01). ARNI therapy was associated with a notable reduction in systolic blood pressure (mean difference [MD] -0.49, 95% CI -0.70 to -0.29, p < 0.001) and an increase in serum creatinine levels (MD 0.30, 95% CI 0.10–0.49, p < 0.001). However, no significant change in serum potassium levels was observed (MD 0.00, 95% CI -0.61–0.61, p = 0.99).

Conclusions

The addition of ARNIs to standard HF therapy may enhance functional outcomes in ACHD patients. However, the increased risk of hypotension and elevated serum creatinine levels necessitates careful monitoring. Further research is essential to better define the role of ARNIs in managing ACHD-related HF.

Registration

URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42024591442.

查看原文本刊更多论文

血管紧张素受体-奈普利素抑制剂对成人先天性心脏病所致慢性心力衰竭的影响：一项系统综述和荟萃分析

心衰（HF）是成人先天性心脏病（ACHD）的重要并发症，通常需要先进的治疗策略。血管紧张素受体-neprilysin抑制剂（ARNIs）已成为血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）在心衰治疗中有前景的替代品。然而，它们在与achd相关的心衰中的安全性和有效性尚不清楚。本系统综述和荟萃分析旨在评估ARNIs对这一独特患者群体功能和安全性结局的影响。方法：我们对已发表的评估aris在ACHD合并HF患者中的应用的研究进行了系统回顾和荟萃分析，并将其与acei / arb进行了比较。主要终点是纽约心脏协会（NYHA）功能分级（FC）的变化。此外，我们评估了ARNIs在该人群中的安全性。我们的荟萃分析包括14项研究，共305例患者。用ARNIs替代acei / arb可显著改善NYHA功能分类(对数比值比[log OR] 0.67, 95% CI 0.15-1.19；P = 0.01)。ARNI治疗与收缩压显著降低相关(平均差[MD] -0.49, 95% CI -0.70 ~ -0.29, p <；0.001)和血清肌酐水平升高(MD 0.30, 95% CI 0.10-0.49, p <；0.001)。然而，血清钾水平未见显著变化（MD 0.00, 95% CI -0.61-0.61, p = 0.99）。结论在标准HF治疗的基础上添加ARNIs可改善ACHD患者的功能结局。然而，低血压和血清肌酐水平升高的风险增加，需要仔细监测。进一步的研究是必要的，以更好地确定ARNIs在管理achd相关心衰中的作用。RegistrationURL: https://www.crd.york.ac.uk/prospero;唯一标识符：CRD42024591442。

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JHLT Open

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