Key result
Shorter ARNI duration before ICD implantation linked to ~10% lower odds of reverse remodeling.
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Why the study?
The optimal duration of angiotensin receptor-neprilysin inhibitor exposure before ICD implantation and predictors of post-implant latent left ventricular reverse remodeling in NIDCM remain unclear.
Does the duration of pre-ICD ARNI therapy predict latent left ventricular reverse remodeling at 1-year post-implant in patients with nonischemic dilated cardiomyopathy?
Cohort (n=75)
Does the duration of pre-ICD ARNI therapy predict latent left ventricular reverse remodeling at 1-year post-implant in patients with nonischemic dilated cardiomyopathy?
Shorter ARNI exposure before ICD implantation in nonischemic dilated cardiomyopathy is associated with delayed reverse remodeling post-implant, underscoring the importance of allowing sufficient time on optimized guideline-directed medical therapy before device implantation.
Shorter pre-ICD ARNI duration was associated with latent LVRR; leaves open whether extending GDMT before implantation improves remodeling in nonischemic cardiomyopathy.
BACKGROUND: The optimal duration of angiotensin receptor-neprilysin inhibitor (ARNI) exposure before implantable cardioverter-defibrillator (ICD) implantation remains undefined. In nonischemic dilated cardiomyopathy (NIDCM), reverse remodeling may continue beyond device implantation. However, predictors of post-implant latent left ventricular reverse remodeling (LVRR) remain unclear. OBJECTIVE: This study investigated the association between duration of pre-ICD ARNI therapy and latent LVRR in patients with NIDCM. METHODS: Seventy-five patients with NIDCM (69.3% male, mean age 61 years) with LVEF of ≤35% and prior ARNI treatment before primary prevention ICD implantation were retrospectively analyzed. Latent LVRR was defined as an absolute ≥10% increase in LVEF with a final LVEF of ≥40% at 1-year post-implant. Multivariable logistic regression identified the predictors of latent LVRR. RESULTS: At 1 year, 22 patients (29.3%) exhibited latent LVRR. Shorter duration from heart failure diagnosis (4.8 vs 30.1 months; odds ratio, 0.88, P = .007) and ARNI initiation (2.3 vs 7.2 months; odds ratio, 0.90, P = .029) to ICD implant were independently associated with latent LVRR. Cardiac magnetic resonance imaging analysis showed uniformly elevated fibrosis markers across groups, with no difference observed in native T1, T2, extracellular volume, or late gadolinium enhancement. Conventional variables, including age, sex, QRS duration, heart rate, and late gadolinium enhancement burden, were not predictive. Over a median follow-up of 33.8 months, ventricular arrhythmia incidence was comparable (9.1% vs 7.5%). CONCLUSION: Shorter ARNI exposure before ICD implantation was independently associated with latent LVRR, highlighting the need for sufficient guideline-directed medical therapy to optimize reverse remodeling, whereas residual arrhythmic risk warrants continued ICD protection.
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Lee et al. (2026) conducted a cohort in Nonischemic dilated cardiomyopathy (NIDCM) (n=75). Duration of pre-ICD ARNI therapy was evaluated on Latent left ventricular reverse remodeling (absolute ≥10% increase in LVEF with a final LVEF of ≥40%) at 1-year post-implant (OR 0.90, p=0.029). Shorter duration from ARNI initiation to ICD implantation was independently associated with latent left ventricular reverse remodeling (OR 0.90; P=0.029) in patients with nonischemic cardiomyopathy.
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