Pătru Oana, Luca Silvia, Cozma Dragoș, Văcărescu Cristina, Crișan Simina, Valcovici Mihaela Daniela, Vîrtosu Mirela, Zus Adrian Sebastian, Luca Constantin Tudor, Drăgan Simona Ruxanda
Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania.
Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania.
J Clin Med. 2025 Apr 16;14(8):2743. doi: 10.3390/jcm14082743.
Cardiac resynchronization therapy (CRT) and angiotensin receptor-neprilysin inhibitors (ARNIs) are cornerstone therapies for patients with heart failure with reduced ejection fraction (HFrEF). However, nearly 30% of patients show no significant response to CRT alone. The potential of ARNI to enhance CRT outcomes-especially in non-responders-is an emerging field of interest. The objective of this review is to systematically evaluate and synthesize the available evidence on the clinical outcomes of combining CRT with ARNI therapy in patients with HFrEF. We conducted a comprehensive search of PubMed, Scopus, and Google Scholar up to September 2024, using the keywords "CRT and ARNI" and "cardiac resynchronization therapy and sacubitril/valsartan". We included retrospective and prospective clinical studies, observational studies, and review articles reporting on patients with HFrEF treated with both CRT and ARNI. Studies not in English, animal studies, and those without full-text availability were excluded. Study selection and data extraction were performed in duplicate by independent reviewers, using PRISMA guidelines for transparency. The final selection included 8 studies published in the last four years, summarized by design, population, outcomes, and statistical significance. The reviewed studies suggest that ARNI therapy, when combined with CRT, may contribute to improvements in left ventricle ejection fraction (LVEF), NYHA functional class, and ventricular remodeling, particularly in CRT non-responders. Some studies also report a potential reduction in ventricular arrhythmias and implantable cardioverter-defibrillator (ICD) interventions. However, outcomes varied across subgroups, and the influence of ARNI timing relative to CRT implantation remains inconclusive. Limitations: Heterogeneity in study designs and small sample sizes in some included studies limited the ability to conduct a meta-analysis. This review is not registered. ARNI therapy shows promise in enhancing CRT response in patients with HFrEF, particularly in non-responders. Further large-scale, prospective studies are needed to clarify optimal patient selection and treatment sequencing.
心脏再同步治疗（CRT）和血管紧张素受体脑啡肽酶抑制剂（ARNI）是射血分数降低的心力衰竭（HFrEF）患者的基础治疗方法。然而，近30%的患者对单纯CRT无明显反应。ARNI增强CRT疗效的潜力——尤其是在无反应者中——是一个新兴的研究领域。本综述的目的是系统评价和综合关于HFrEF患者联合CRT与ARNI治疗临床结局的现有证据。我们对截至2024年9月的PubMed、Scopus和谷歌学术进行了全面检索，使用关键词“CRT和ARNI”以及“心脏再同步治疗和沙库巴曲缬沙坦”。我们纳入了报告接受CRT和ARNI治疗的HFrEF患者的回顾性和前瞻性临床研究、观察性研究及综述文章。非英文研究、动物研究以及无全文的研究被排除。由独立 reviewers 使用PRISMA指南以确保透明度，对研究进行了重复的选择和数据提取。最终入选的包括过去四年发表的8项研究，按设计、人群、结局和统计学意义进行了总结。综述研究表明，ARNI治疗与CRT联合使用时，可能有助于改善左心室射血分数（LVEF）、纽约心脏协会（NYHA）功能分级和心室重构，特别是在CRT无反应者中。一些研究还报告了室性心律失常和植入式心脏复律除颤器（ICD）干预可能减少。然而，各亚组的结局存在差异，ARNI相对于CRT植入的时机影响仍不确定。局限性：研究设计的异质性以及一些纳入研究的样本量较小，限制了进行荟萃分析的能力。本综述未注册。ARNI治疗在增强HFrEF患者，尤其是无反应者的CRT反应方面显示出前景。需要进一步的大规模前瞻性研究来明确最佳的患者选择和治疗顺序。
