ARNI therapy significantly improved NYHA functional class (RR 0.41; 95% CI 0.22-0.76; p=0.001) and reduced NT-pro-BNP levels (p=0.02) in adult patients with complex congenital heart disease.
Meta-Analysis (n=134)
Does ARNI therapy improve clinical outcomes (NYHA class, 6MWT, NT-pro-BNP) in adult patients with complex congenital heart disease and heart failure?
ARNI therapy may improve NYHA functional class and reduce NT-pro-BNP levels in adult patients with complex congenital heart disease and heart failure, though current evidence is limited by small, heterogeneous observational studies.
Estimación del efecto: RR 0.41 (95% CI 0.22-0.76)
valor p: p=0.001
Abstract Background Over 90% of patients with congenital heart disease now survive into adulthood due to advances in medical, surgical, and technological interventions. However, the care of patients with complex adult congenital heart disease (ACHD) remains a challenge due to a lack of data on effective management strategies. Heart failure (HF) remains the leading cause of mortality in this population, and treatments developed for acquired heart failure may not be directly applicable due to differences in pathophysiology. Angiotensin receptor-neprilysin inhibitors (ARNIs) have shown efficacy in treating heart failure in adults with acquired conditions, but evidence for their use in ACHD is limited. Objective This study aimed to evaluate the efficacy of ARNI in improving clinical outcomes in adult patients with complex congenital heart disease. Methods A systematic review and meta-analysis of studies published until 2 024 were conducted by two independent reviewers who searched databases including PubMed, Cochrane Library, and CENTRAL. Eligible studies included prospective and retrospective cohorts involving ACHD patients with reduced ventricular systolic function or heart failure symptoms. Primary and secondary outcomes included changes in NYHA functional class, 6-minute walk test (6MWT), and NT-pro-BNP levels. The data were analyzed using a random-effects model. Sensitivity analysis was performed to assess the robustness of the results by excluding studies with high risk of bias. Results Eight studies were included, involving 134 patients. Analysis revealed significant improvements in NYHA functional class (RR 0.41; 95% CI 0.22-0.76; p= 0.001; I2=71%) and reduction in NT-pro-BNP levels (p=0.02; I2= 71%) after ARNI therapy. However, the studies included in the analysis had substantial heterogeneity. There was no significant improvement in 6MWT performance after ARNI therapy. Sensitivity analysis showed that exclusion of studies with a high risk of bias slightly altered the effect size for NYHA functional class and 6MWT, but the overall trend remained consistent. Conclusion ARNI therapy appears to improve NYHA functional class and reduce NT-pro-BNP levels in ACHD patients, suggesting potential benefits in managing heart failure in this population. The reduction in heterogeneity after excluding studies with high bias further supports the validity of ARNI as a therapeutic option in ACHD patients. However, significant heterogeneity among studies highlights the need for larger, randomized clinical trials to confirm these findings and explore additional outcomes, such as hospitalization rates and cardiovascular mortality.Forest plot of NYHA Functional Class Forest plot of NT-ProBNP Levels
Cruz et al. (Sat,) conducted a meta-analysis in Complex adult congenital heart disease (ACHD) with heart failure (n=134). Angiotensin receptor-neprilysin inhibitors (ARNI) was evaluated on Changes in NYHA functional class, 6-minute walk test (6MWT), and NT-pro-BNP levels (RR 0.41, 95% CI 0.22-0.76, p=0.001). ARNI therapy significantly improved NYHA functional class (RR 0.41; 95% CI 0.22-0.76; p=0.001) and reduced NT-pro-BNP levels (p=0.02) in adult patients with complex congenital heart disease.