Angiotensin-neprilysin inhibition in acute decompensated heart failure: a meta-analysis of randomized controlled trials.

IF 1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Future cardiology Pub Date : 2025-07-21 DOI:10.1080/14796678.2025.2535218

Hosam I Taha, Abdalhakim Shubietah, Bashar M Al Zoubi, Mohamed S Elgendy, Hazem Reyad Mansour, Anas Abdulkader, Abdelrahman M Ghazal, Noura Shamis, Mohamed Abuelazm, Mustafa Turkmani, Robert J Mentz

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引用次数: 0

Abstract

Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.

Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.

Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).

Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

Protocol registration: PROSPERO: CRD42024618027.

查看原文本刊更多论文

急性失代偿性心力衰竭的血管紧张素-萘普利素抑制：随机对照试验的荟萃分析。

背景：血管紧张素受体- neprilysin抑制剂（ARNI）已被证实用于慢性心力衰竭（HF）伴射血分数降低。然而，它们在急性失代偿（ADHF）稳定后的疗效和安全性尚不清楚。本荟萃分析评估了adhf后ARNI与血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs）的对比。方法：对截至2024年11月PubMed、Scopus、WOS、Embase和CENTRAL的随机对照试验（rct）进行meta分析。采用95%置信区间（CI）的风险比（RR）和标准化平均差异（SMD）。结果：纳入3项随机对照试验（rct），共1741例患者。ADHF稳定后使用ARNI可显著降低HF再住院/全因死亡率(RR: 0.71；95% ci: 0.57-0.88；p p = 0.01)、肾功能恶化(RR: 0.80；95% ci: 0.64-1.00；p = 0.048)，第4周NT-proBNP (SMD: -0.24；95% CI: -0.34 ~ -0.14；p = 0.0001)。然而，ARNI增加了症状性低血压的风险(RR: 1.33；95% ci: 1.04-1.71；p = 0.024)。结论：ADHF稳定后开始ARNI比acei / arb对心血管和肾脏结局更有效，尽管有更高的症状性低血压风险。协议注册：PROSPERO: CRD42024618027。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Future cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.80

自引率

5.90%

发文量

期刊介绍： Research advances have contributed to improved outcomes across all specialties, but the rate of advancement in cardiology has been exceptional. Concurrently, the population of patients with cardiac conditions continues to grow and greater public awareness has increased patients" expectations of new drugs and devices. Future Cardiology (ISSN 1479-6678) reflects this new era of cardiology and highlights the new molecular approach to advancing cardiovascular therapy. Coverage will also reflect the major technological advances in bioengineering in cardiology in terms of advanced and robust devices, miniaturization, imaging, system modeling and information management issues.