Das Bibhuti B, Deshpande Shriprasad, Nikolaidis Lazaros, Niu Jianli
University of Mississippi Medical Center, Jackson, Mississippi.
Children's National Hospital, The George Washington University, Washington DC, Washington.
JHLT Open. 2025 Feb 18;8:100230. doi: 10.1016/j.jhlto.2025.100230. eCollection 2025 May.
Heart failure (HF) is a significant complication in adults with congenital heart disease (ACHD), often requiring advanced therapeutic strategies. Angiotensin receptor-neprilysin inhibitors (ARNIs) have emerged as a promising alternative to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HF management. However, their safety and efficacy in ACHD-related HF remain unclear. This systematic review and meta-analysis aim to evaluate the impact of ARNIs on functional and safety outcomes in this unique patient population.
We conducted a systematic review and meta-analysis of published studies assessing the use of ARNIs in ACHD patients with HF, comparing them to ACEIs/ARBs. The primary outcome was the change in New York Heart Association (NYHA) functional class (FC). Additionally, we assessed the safety profile of ARNIs in this population.
Our meta-analysis included 14 studies encompassing 305 patients. Substituting ACEIs/ARBs with ARNIs significantly improved the NYHA functional class (log odds ratio [log OR] 0.67, 95% CI 0.15-1.19; = 0.01). ARNI therapy was associated with a notable reduction in systolic blood pressure (mean difference [MD] -0.49, 95% CI -0.70 to -0.29, < 0.001) and an increase in serum creatinine levels (MD 0.30, 95% CI 0.10-0.49, < 0.001). However, no significant change in serum potassium levels was observed (MD 0.00, 95% CI -0.61-0.61, = 0.99).
The addition of ARNIs to standard HF therapy may enhance functional outcomes in ACHD patients. However, the increased risk of hypotension and elevated serum creatinine levels necessitates careful monitoring. Further research is essential to better define the role of ARNIs in managing ACHD-related HF.
URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42024591442.
心力衰竭（HF）是成人先天性心脏病（ACHD）的一种重要并发症，通常需要先进的治疗策略。在心力衰竭管理中，血管紧张素受体脑啡肽酶抑制剂（ARNI）已成为血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）的一种有前景的替代药物。然而，它们在ACHD相关心力衰竭中的安全性和有效性仍不明确。本系统评价和荟萃分析旨在评估ARNI对这一独特患者群体功能和安全性结局的影响。
我们对已发表的评估ARNI在ACHD合并HF患者中应用的研究进行了系统评价和荟萃分析，并将其与ACEI/ARB进行比较。主要结局是纽约心脏协会（NYHA）心功能分级（FC）的变化。此外，我们评估了ARNI在该人群中的安全性。
我们的荟萃分析纳入了14项研究，共305例患者。用ARNI替代ACEI/ARB可显著改善NYHA心功能分级（对数比值比[log OR]0.67，95%可信区间0.15 - 1.19；P = 0.01）。ARNI治疗与收缩压显著降低（平均差值[MD] -0.49，95%可信区间 -0.70至 -0.29，P < 0.001）和血清肌酐水平升高（MD 0.30，95%可信区间0.10 - 0.49，P < 0.001）相关。然而，未观察到血清钾水平有显著变化（MD 0.00，95%可信区间 -0.61至0.61，P = 0.99）。
在标准心力衰竭治疗中添加ARNI可能会改善ACHD患者的功能结局。然而，低血压风险增加和血清肌酐水平升高需要密切监测。进一步的研究对于更好地确定ARNI在管理ACHD相关心力衰竭中的作用至关重要。
网址：https://www.crd.york.ac.uk/prospero；唯一标识符：CRD42024591442。
