Cheng Caiming, Nie Yu, Chen Di, Yang Yan, Liang Shunji, Yu Qin
Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Department of Geriatrics, No.903 Hospital of PLA Joint Logistics Support Force, Hangzhou, China.
Front Cardiovasc Med. 2025 Aug 12;12:1550624. doi: 10.3389/fcvm.2025.1550624. eCollection 2025.
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).
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.
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.
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.
本研究旨在评估血管紧张素受体脑啡肽酶抑制剂（ARNI）对急性心肌梗死（AMI）合并心力衰竭（HF）患者心肌能量代谢及预后的影响。
对我院中心收治的244例诊断为AMI合并HF的住院患者资料进行回顾性分析。其中，210例患者完成了1年的随访。根据血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）/ARNI的使用情况，将210例患者分为ARNI组（107例，51.0%）和非ARNI（ACEI/ARB）组（103例，49.0%）。主要观察指标为1年随访后心肌能量消耗（MEE）的变化及预后指标。
与ACEI/ARB相比，ARNI在1年后显著降低了MEE[（129.61±40.81）kcal/min对（154.49±47.58）kcal/min，<0.01]。HFrEF组的MEE水平显著高于HFmrEF组（<0.05）。ARNI组的心力衰竭发生率（23.0%对43.4%，=0.001）、再发心肌梗死发生率（9.8%对22.1%，=0.009）和肾功能恶化发生率（5.7%对13.1%，=0.049）均显著低于非ARNI组。ROC分析确定MEE（kcal/min）的截断值为178，预测心源性死亡的敏感性为85%，特异性为64%（AUC=0.74，=0.007）。在1年随访期间，MEE超过178 kcal/min的患者与MEE低于178 kcal/min的患者相比，全因死亡风险增加。
与ACEI/ARB相比，ARNI显著降低了MEE。MEE与左心室收缩功能障碍的严重程度及长期预后显著相关。MEE值超过178 kcal/min是心源性死亡的有力预测指标，并与AMI合并HF患者1年全因死亡率增加相关。
