Influence of the Angiotensin Receptor Neprilysin Inhibitor Compared with Perindopril on Left Atrial Strain and Prognosis in Heart Failure

Abstract Backgrounds Contemporary guidelines lack support for the therapies of left atrial (LA) dysfunction. The objective of this study is to compare the effects of angiotensin receptor–neprilysin inhibitor (ARNI) therapy and perindopril on left atrial (LA) strain assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in patients with heart failure with reduced ejection fraction (HFrEF). Methods This single-centre retrospective observational study included patients with HFrEF who received either ARNI therapy or perindopril. The primary endpoint was the change in LA reservoir strain (LASr), LA conduit strain (LAScd), and LA booster strain (LASct) from baseline to 6 months. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACEs). Results Among the 159 enrolled patients, 135 completed the 6-month follow-up (ARNI, n = 80; perindopril, n = 55). Baseline characteristics were comparable between the two groups. After adjustment for potential confounders, ARNI therapy was associated with significantly greater improvement in LASr than perindopril (adjusted mean difference, 4.31%; 95% confidence interval [CI], 3.02–5.60; P < 0.05). Similar benefits were observed for LAScd and LASct (both P < 0.05). MACEs occurred in 6 patients (6.1%) in the ARNI group and 17 patients (28.3%) in the perindopril group (log-rank P < 0.05). Conclusions In patients with HFrEF, ARNI therapy was associated with greater improvement in LA strain and a lower incidence of MACEs than perindopril over 6 months.