Should We Retain Half-Dose ARNIs in HFrEF? Lessons Learned from Reverse Remodeling using CORE-HF Real-World Data
Article Type:
Research/Original Article (دارای رتبه معتبر)

Heart failure (HF) is a progressive health problem with high mortality and morbidity rates in both developed and developing countries. Patients with HF who develop reverse remodeling during treatment have better outcomes and lower mortality. Real-world data on the reverse remodeling effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor-neprilysin inhibitors (ARNIs) in Indonesians are yet to be available.


This study aimed to compare the reverse cardiac remodeling of patients with heart failure with reduced ejection fraction (HFrEF) treated for six months with an ARNI or ACEI based on the CORE-HF registry.


We conducted a non-experimental, sub-analysis study of the CORE-HF database at the Heart Failure Clinic of Universitas Sebelas Maret Hospital from 2018 to 2021. One group had been treated with ARNIs, while the other was administered with the optimal tolerated ACEI. A six-month follow-up was carried out to determine left ventricle reverse remodeling (LVRR) and functional class alteration as endpoints.


While 89.2% of those in the ACEI group could tolerate the maximum dose, only one person in the ARNI group received the maximum dose, with the majority receiving half the maximum dose (100 mg BID). After six months, LVRR occurred at a similar rate in both groups (26.31% for ARNI and 26.15% for ACEI; P = 0.989). However, the New York Heart Association functional class improved more in the ARNI group (mean 0.95 ± 0.7 vs. 0.62 ± 0.86; P = 0.128).


Despite similar LVRR and functional capacity improvements, a slightly better echocardiography improvement was observed in the ACEI arm. We postulate that full intervention of the renin-angiotensin-aldosterone system should still be the main goal, together with other guideline-directed medical therapies for HF. Hence, costeffective full-dose of ACEi should be chosen for low- to middle-income countries whose ARNI was not easily available yet due to several issues.

International Cardiovascular Research Journal, Volume:16 Issue: 3, Sep 2022
97 to 102  
دانلود و مطالعه متن این مقاله با یکی از روشهای زیر امکان پذیر است:
اشتراک شخصی
با عضویت و پرداخت آنلاین حق اشتراک یک‌ساله به مبلغ 990,000ريال می‌توانید 60 عنوان مطلب دانلود کنید!
اشتراک سازمانی
به کتابخانه دانشگاه یا محل کار خود پیشنهاد کنید تا اشتراک سازمانی این پایگاه را برای دسترسی نامحدود همه کاربران به متن مطالب تهیه نمایند!
  • حق عضویت دریافتی صرف حمایت از نشریات عضو و نگهداری، تکمیل و توسعه مگیران می‌شود.
  • پرداخت حق اشتراک و دانلود مقالات اجازه بازنشر آن در سایر رسانه‌های چاپی و دیجیتال را به کاربر نمی‌دهد.
In order to view content subscription is required

Personal subscription
Subscribe for 50 € euros via PayPal and download 60 articles during a year.
Organization subscription
Please contact us to subscribe your university or library for unlimited access!