Mechanisms of Angiotensin-Receptor/Neprilysin Inhibition for Heart Failure with Reduced Ejection Fraction

The mechanisms explored in two studies won't supersede outcomes data from PARADIGM-HF.

In the PARADIGM-HF trial, involving patients with heart failure (HF) and reduced left-ventricular (LV) ejection fraction (HFrEF), angiotensin-receptor/neprilysin inhibition (ARNI) with sacubitril–valsartan outperformed enalapril in reducing the risks for cardiovascular death and HF-related hospitalization (NEJM JW Cardiology Oct 2014 and N Engl J Med 2014; 371:993). In two manufacturer-funded studies, investigators have now assessed the possible physiological mechanisms of this benefit, with a focus on cardiovascular remodeling.

In EVALUATE-HF (NCT02874794), researchers randomized 464 patients with HFrEF (mean age, 67; 23% women; mean LVEF, 33%) to receive either sacubitril–valsartan (target dosage, 97/103 mg twice daily) or enalapril (targe…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)