Effects of the Angiotensin‐Receptor Neprilysin Inhibitor on Cardiac Reverse Remodeling: Meta‐Analysis

Figures

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  Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) flow diagram showing detailed study selection process.

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  Figure 2. Forest plot showing changes in functional capacity including (A) NYHA functional class, (B) 6MWD following ARNI, and (C) changes of NYHA functional class comparing ARNI with ACEIs/ARBs. 6MWD indicates 6‐minute walking distance; ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; df, degrees of freedom; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; NYHA, New York Heart Association.

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  Figure 3. Forest plots for (A) effect of ARNI on LVEF and (B) other CRR indices of HFrEF patients. ARNI indicates angiotensin‐receptor neprilysin inhibitor; df, degrees of freedom; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LAV, left atrial volume; LVEF, left ventricular ejection fraction; LVEDD, left ventricular end‐diastolic dimension; LVEDV, left ventricular end‐diastolic volume; LVESD, left ventricular end‐systolic dimension; LVESV, left ventricular end‐systolic volume; LVMI, left ventricular mass index.

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  Figure 4. Forest plots for effect of ARNI on remodeling indexes (LVESV, LVEDV, LVESD, LVEDD, LAV, LVMI) (A) in HFpEF patients following ARNI and (B) effect of ARNI on LVEF compared with ACEIs/ARBs. ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; df, degrees of freedom; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LAV indicates left atrial volume; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end‐systolic volume; LVMI, left ventricular mass index.

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  Figure 5. Forest plots for effect of ARNI on main remodeling indices (LVESV, LVEDV, LVESD, LVEDD, LAV, LVMI) (A) in HFrEF patients and (B) in HFpEF patients following ARNI compared with ACEIs/ARBs. ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin‐receptor neprilysin inhibitor; df, degrees of freedom; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IV, intravenous; LAV, left atrial volume; LVEDD, left ventricular end‐diastolic dimension; LVEDV, left ventricular end‐diastolic volume; LVESD, left ventricular end‐systolic dimension; LVESV, left ventricular end‐systolic volume; LVMI, left ventricular mass index.

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  Figure 6. Fitting curve using cubic curve model to explore the relationship between LVEF and EDD changes. EDD indicates end‐diastolic dimension; LVEF, left ventricular ejection fraction.