ARNI effects in HFrEF. Risk reduction beyond LVEF

Abstract Background The imbalance of cardiac autonomic nervous system function plays an important role in heart failure associated mortality. ARNI has demonstrated a paramount effect reducing risk death and hospitalization for worsening failure. However, its exact mechanism action remains only partly understood. We sought to prospectively compare rate variability as noninvasive measure function. Methods study design was prospective sequential observational. Patients served their own internal control. with reduced ejection fraction (HFrEF) receiving optimal medical therapy who were scheduled switch underwent echocardiography standardized 30-minute 12-lead Holter ECG recording before starting therapy. A monitoring the parameters performed 3 months after start Physicians instructed increase dose highest tolerated or maximum dose. Besides left ventricular (LVEF) we assessed (HR), standard deviation normal-to-normal intervals (SDNN) mean square differences between consecutive R-R (RMSSD). Results recruited 55 patients baseline characteristics follows: age 65±12 years, male sex 78%, NT-proBNP 4989±809 pg/ml, LVEF 28±6%, HR 75±9 bpm, SDNN 43±2 ms, RMSSD 19±2 ms. All received beta-blocker dosage similar at follow-up. After therapy, showed significant reduction 7% (74±14 bpm vs. 69±11 min, P=0.005). increased by 49% (43±2 ms 64±4 P<0.001) 42% (19±2 27±3 P=0.01). These results accompanied (28±6% 38±10%, plasma levels (4989±809 pg/ml 2602±87 P<0.04). NYHA Class affected changed from III II. Conclusion changing ACE/AT1-I ARNI, improvement could be observed. apparently activates parasympathetic suggested decreased RMSSD. Therefore, part cardioprotective beneficial effects may relate restoration Potential regarding incidence sudden arrest these observations. Funding Acknowledgement Type funding sources: None.