Key result
ARNI therapy is linked to ~4-point greater improvement in LA reservoir strain vs. perindopril in HFrEF.
Why the study?
Contemporary guidelines lack support for therapies targeting LA dysfunction, and the comparative effects of ARNI therapy versus perindopril on LA strain assessed by 3D-STE in HFrEF patients needed investigation.
Does angiotensin receptor–neprilysin inhibitor (ARNI) therapy improve three-dimensional left atrial strain and reduce major adverse cardiovascular events compared with perindopril in patients with heart failure with reduced ejection fraction (HFrEF)?
Observational (n=159)
Single-blind
No
Does angiotensin receptor–neprilysin inhibitor (ARNI) therapy improve three-dimensional left atrial strain and reduce major adverse cardiovascular events compared with perindopril in patients with heart failure with reduced ejection fraction (HFrEF)?
In patients with HFrEF, ARNI therapy is associated with significantly greater improvements in 3D left atrial phasic strain parameters and a lower 6-month incidence of major adverse cardiovascular events compared with perindopril.
ARNI-associated left atrial strain gains in HFrEF warrant prospective validation; does not yet support practice change.
Backgrounds Contemporary guidelines lack support for the therapies of left atrial (LA) dysfunction. The objective of this study is to compare the effects of angiotensin receptor–neprilysin inhibitor (ARNI) therapy and perindopril on left atrial (LA) strain assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in patients with heart failure with reduced ejection fraction (HFrEF). Methods This single-centre retrospective observational study included patients with HFrEF who received either ARNI therapy or perindopril. The primary endpoint was the change in LA reservoir strain (LASr), LA conduit strain (LAScd), and LA booster strain (LASct) from baseline to 6 months. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACEs). Results Among the 159 enrolled patients, 135 completed the 6-month follow-up (ARNI, n = 80; perindopril, n = 55). Baseline characteristics were comparable between the two groups. After adjustment for potential confounders, ARNI therapy was associated with significantly greater improvement in LASr than perindopril (adjusted mean difference, 4.31%; 95% confidence interval [CI], 3.02–5.60; P < 0.05). Similar benefits were observed for LAScd and LASct (both P < 0.05). MACEs occurred in 6 patients (6.1%) in the ARNI group and 17 patients (28.3%) in the perindopril group (log-rank P < 0.05). Conclusions In patients with HFrEF, ARNI therapy was associated with greater improvement in LA strain and a lower incidence of MACEs than perindopril over 6 months.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=159). Angiotensin receptor-neprilysin inhibitor (ARNI) vs. Perindopril was evaluated on Adjusted 6-month left atrial reservoir strain (LASr) (MD 4.31%, 95% CI 3.02-5.60, p=<0.05). ARNI therapy was associated with a significantly greater improvement in 6-month left atrial reservoir strain compared with perindopril in HFrEF patients (adjusted MD 4.31%, 95% CI 3.02-5.60; P<0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: