Therapies for persistent left ventricular dysfunction following myocardial infarction: stick or twist?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: persistent left ventricular dysfunction following myocardial infarction. Intervention: SGLT2 inhibitors and ARNI.

Q: What does this research mean for the field?

The management of persistent left ventricular dysfunction following myocardial infarction involves evaluating whether to continue established therapies or adopt new treatment strategies. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Robin A P Weir

doi:10.1093/ehjcvp/pvag066

August 20, 2026European Heart Journal - Cardiovascular PharmacotherapyOpen Access

Therapies for persistent left ventricular dysfunction following myocardial infarction: stick or twist?

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Key result

Current evidence does not support the routine use of SGLT2 inhibitors or ARNI therapy early after myocardial infarction, and patients should be reassessed at 3 months for chronic heart failure criteria.

Why the study?

Does SGLT2 inhibitor or ARNI therapy improve outcomes in patients with left ventricular dysfunction early after myocardial infarction?

Key Points

To review clinical trial evidence evaluating the timing of initiating SGLT2 inhibitors and ARNI therapy following acute myocardial infarction with left ventricular dysfunction.
Comparative analysis of patient baseline characteristics, trial designs, and primary endpoints across acute post-myocardial infarction trials (DAPA-MI, EMPACT-MI, PARADISE-MI) versus chronic heart failure trials (DAPA-HF, EMPEROR-REDUCED, PARADIGM-HF).
Evaluation of biological mechanisms governing early versus late post-infarction left ventricular remodeling and myocardial stunning under contemporary revascularization and medical therapy.
Acute post-MI trials enrolled well-treated cohorts (89% revascularized; 78% to 92% on ACEi/ARB; 85% to 90% on beta-blockers) with modest baseline impairment (mean LVEF 44% in DAPA-MI, 42% in EMPACT-MI, and 37% in PARADISE-MI), failing to achieve primary outcome reductions in cardiovascular death or heart failure hospitalization.
In contrast, chronic heart failure trials enrolled higher-risk cohorts with lower baseline systolic function (mean LVEF 27% to 31%) and symptomatic congestion (NYHA class II-IV), while explicitly excluding patients with recent myocardial infarction within the preceding 90 days or 12 weeks.
Routine early intensification with SGLT2i or sacubitril-valsartan is not supported; left ventricular function should instead be reassessed at approximately 3 months post-infarction, with therapy escalation reserved for patients fulfilling chronic heart failure criteria (LVEF ≤40%, NYHA II-IV, elevated natriuretic peptides).

Structured PICO

Does SGLT2 inhibitor or ARNI therapy improve outcomes in patients with left ventricular dysfunction early after myocardial infarction?

P

Population

Patients with left ventricular dysfunction following acute myocardial infarction

I

Intervention

SGLT2 inhibitors (dapagliflozin, empagliflozin) or ARNI (sacubitril-valsartan) initiated early (0-14 days) after myocardial infarction

C

Comparator

Standard post-myocardial infarction care (including ACEi/ARB, beta-blockers, and MRA)

O

Outcome

Composite of cardiovascular death or heart failure hospitalizationcomposite

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Implication

Routine use of SGLT2 inhibitors or ARNI early after myocardial infarction is not currently supported by evidence, and intensification of heart failure therapies should be reserved for patients meeting chronic heart failure criteria at 3 months post-MI.

Abstract

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Cite This Study

Robin A P Weir (2026) conducted an editorial in persistent left ventricular dysfunction following myocardial infarction. SGLT2 inhibitors and ARNI was evaluated. Current evidence does not support the routine use of SGLT2 inhibitors or ARNI therapy early after myocardial infarction, and patients should be reassessed at 3 months for chronic heart failure criteria.

synapsesocial.com/papers/6a8aae507677a34114447374 https://doi.org/10.1093/ehjcvp/pvag066

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Therapies for persistent left ventricular dysfunction following myocardial infarction: stick or twist?

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Therapies for persistent left ventricular dysfunction following myocardial infarction: stick or twist?

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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