Effect of Angiotensin Receptor-Neprilysin Inhibitor on Cardiac Remodeling in Heart Failure with Reduced Ejection Fraction in Kuwait

Background: Heart failure with reduced ejection fraction (HFrEF) is a growing concern in the Middle East and worldwide, despite advances in treatment. The introduction of angiotensin receptor-neprilysin inhibitor (ARNI) has shown promise in managing HFrEF by inhibiting the renin–angiotensin–aldosterone system. However, its effects on cardiac remodeling and outcomes in the Middle East are poorly understood. Objectives: To determine the effectiveness and safety of ARNI in improving outcomes for HFrEF patients in Kuwait. Methods: This observational study, conducted at Al Dabbous Cardiac Center in Kuwait, included 114 adult HFrEF patients treated with ARNI for 6 months. Data on patient characteristics, echocardiographic measurements, and clinical parameters were collected before and after treatment. Statistical analysis was performed using paired t -tests and nonparametric sign tests. Results: Following ARNI treatment, significant improvements were observed in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), right ventricular systolic pressure (RVSP), and New York Heart Association Functional Classification. LVEF increased from 29.54% to 32.22% ( P < 0.001). LVEDD and RVSP decreased significantly ( P < 0.001, P = 0.016, respectively), while systolic blood pressure decreased ( P = 0.002). The study showed no significant changes in weight or potassium levels. Adverse effects were minimal. Conclusions: This study contributes to the growing body of evidence supporting ARNI’s effectiveness in improving outcomes for HFrEF patients, particularly in a Middle Eastern population. ARNI treatment resulted in significant improvements in cardiac remodeling and clinical parameters, emphasizing its potential as a valuable therapeutic option for HFrEF patients. Additional research is essential to optimize ARNI’s use and enhance patient outcomes.