Effects of angiotensin receptor-neprilysin inhibition on myocardial energy metabolism and prognosis in patients with acute myocardial infarction complicated by heart failure.

OBJECTIVE

This study aims to evaluate the effects of angiotensin receptor-neprilysin inhibitor (ARNI) on myocardial energy metabolism and prognosis in patients with acute myocardial infarction (AMI) complicated by heart failure (HF).

METHODS

A retrospective analysis was conducted on data from 244 inpatients admitted to our center, who were diagnosed with AMI complicated by HF. Among these patients, 210 completed a 1-year follow-up. According to the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)/ARNI, the 210 patients were divided into the ARNI group (107 cases, 51.0%) and the non-ARNI (ACEI/ARB) group (103 cases, 49.0%). The main outcome measures were the changes in myocardial energy expenditure (MEE) and prognostic indicators after 1-year follow-up.

RESULTS

ARNI significantly reduced MEE after 1 year compared with the ACEI/ARB [(129.61 ± 40.81) kcal/min vs. (154.49 ± 47.58) kcal/min,  < 0.01]. The MEE level in the HFrEF group was significantly higher than that in the HFmrEF group ( < 0.05). The ARNI group showed significantly lower rates of heart failure (23.0% vs. 43.4%,  = 0.001), recurrent myocardial infarction (9.8% vs. 22.1%,  = 0.009), and renal function deterioration (5.7% vs. 13.1%,  = 0.049) than those in the non-ARNI group. ROC analysis identified an MEE (kcal/min) cutoff value of 178, with 85% sensitivity and 64% specificity for the prediction of cardiac death (AUC = 0.74,  = 0.007). During the 1-year follow-up, patients with MEE over 178 kcal/min were associated with increased risk of all-cause death compared with those with MEE below 178 kcal/min.

CONCLUSION

ARNI significantly reduced MEE compared with ACEI/ARB. MEE was significantly associated with the severity of left ventricular systolic dysfunction and long-term prognosis. An MEE value over 178 kcal/min was a powerful predictor of cardiac death and linked with increased risk of 1-year all-cause mortality in patients with AMI complicated by HF.