Abstract
Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium–glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e′ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.
Highlights
In recent years, innovative developments have been made in the management of heart failure (HF), based on robust evidence from landmark trials of angiotensin receptor-neprilysin inhibitors (ARNI) and sodium–glucose co-transporter-2 inhibitors (SGLT2i)[1,2,3]
This study aimed to investigate whether a combination of an Angiotensin receptor-neprilysin inhibitor (ARNI) and a SGLT2i could be more effective in improving cardiac function and disease prognosis in diabetic patients with heart failure with reduced ejection fraction (HFrEF)
Propensity score matching in a 1:1:1:1 ratio for age, sex, body mass index, systolic blood pressure, hypertension, chronic kidney disease, atrial fibrillation, creatinine, glomerular infiltration rate, total cholesterol, hemoglobin A1c protein, NT-proBNP, left ventricular (LV)-EF and LV end-diastolic volume (LV-EDV), and the use of beta blockers, renin-angiotensin system (RAS) blockers, mineralocorticoid receptor antagonists (MRA), loop diuretics, antiplatelet drugs, oral anticoagulants, statins, insulin, and metformin was used to select a total of 206 patients for the study
Summary
Innovative developments have been made in the management of heart failure (HF), based on robust evidence from landmark trials of angiotensin receptor-neprilysin inhibitors (ARNI) and sodium–glucose co-transporter-2 inhibitors (SGLT2i)[1,2,3]. ARNI reduces cardiovascular mortality and hospital admissions in patients with heart failure with reduced ejection fraction (HFrEF), regardless of the presence of diabetes. They have been shown to results in left ventricular (LV) reverse remodeling, with decreased levels of N-terminal probrain natriuretic peptide (NT-proBNP)[5,6]. There are limited studies investigating the prognosis and the changes in cardiac function in patients treated with a combination of ARNI and SGLT2i. This study aimed to investigate whether a combination of an ARNI and a SGLT2i could be more effective in improving cardiac function and disease prognosis in diabetic patients with HFrEF
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
