Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
ARNI therapy improves autonomic cardiac function in heart failure with reduced ejection fraction
A. Böhmer1, T. F. Schubert1, L. von Stülpnagel2, F. Theurl3, M. Schreinlechner4, B.-C. Dobre5, A. Bauer6, B. Kaess1, J. Ehrlich5
1Medizinische Klinik I - Kardiologie, St. Josefs Hospital GmbH, Wiesbaden; 2Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; 3Kardiologie, Medizinische Universität Innsbruck, Innsbruck, AT; 4Department für Innere Medizin III - Kardiologie und Angiologie, Medizinische Universität Innsbruck, Innsbruck, AT; 5Medizinische Klinik I, St. Josefs Hospital, Wiesbaden; 6Kardiologie und Angiologie, Tirol Kliniken GmbH, Innsbruck, AT;

Background

Mortality in heart failure with reduced ejection fraction (HFrEF) has been clearly associated with dysfunction and imbalance of cardiac autonomic nervous system (CANS). Sacubitril/Valsartan (ARNI) reduces cardiovascular mortality and HFrEF-hospitalization. Whether ARNI effects CANS has not been studied. 

Methods

This study was designed to investigate the influence of ARNI therapy on heart rate variability (HRV), heart rate (HR), deceleration capacity (DC) and periodic repolarization dynamics (PRD) as noninvasive measures of CANS in patients with HFrEF. Patients underwent standardized 12-lead-Holter-ECG in supine and standing position before and 3 months after initiation of ARNI therapy. Endpoints were changes in HRV parameters (standard deviation of normal-to-normal intervals [SDNN], mean square of differences between consecutive R-R intervals [RMSSD]), HR, DC and PRD as well as left ventricular ejection fraction (LVEF) and nt-proBNP plasma levels.

Results

Between June 2021 and March 2022, we analyzed 48 consecutive HFrEF patients (66±13 years, 88% male). At follow-up we found a significant increase in SDNN (supine: 30±17ms vs. 42±22ms, P<0.001 and standing: 27±12ms vs. 39±13ms, P<0.001), RMSDD (supine: 14±9ms vs. 22±15ms, P<0.001 and standing: 12±8ms vs. 17±11ms, P=0.002) and DC (supine: -0.2±9.3ms vs. 3.7±7.4ms, P=0.004 and standing: -0.6±8.2ms vs. 2.2±6.5ms, P=0.029) accompanied by a significant reduction in HR (supine: 73±9bpm vs. 67±4bpm, P<0.001 and standing: 80±9bpm vs. 75±11bpm, P=0.007). No difference was seen concerning PRD (supine: 7.6±5.9deg2 vs. 6.0±4.3deg2, P=0.09 and standing: 9.7±5.8deg2 vs. 9.4±4.5deg2, P=0.69). HRV changes were accompanied by increased LVEF (27±6% vs. 39±9%, P<0.001) and reduced plasma nt-proBNP (4528±4697pg/ml vs. 1803±4992pg/ml, P=0.004). Regression analysis demonstrated significant relationship between changes in nt-proBNP and SDNN, RMSSD and HR.

Conclusion

After initiation of ARNI therapy significant increases of parasympathetic CANS tone as evidenced by increased SDNN, RMSSD and DC as well as decreased HR were observed. Rebalancing of autonomic status may contribute to beneficial effects of ARNI in patients with HFrEF.
https://dgk.org/kongress_programme/jt2023/aP545.html