ARNI vs ACE Inhibitors in Improving Left Ventricular Geometry, Diastolic Function, and Cardiac Power Output in HFrEF Patients: A Prospective Cohort Study among Acehnese, Indonesia

Authors

Taufiqurrahman , Teuku Heriansyah , Adi Purnawarman , Novita , Zulkarnain

DOI:

10.29303/jppipa.v11i4.10593

Published:

2025-04-25

Issue:

Vol. 11 No. 4 (2025): April

Keywords:

ACE inhibitors, ARNI, Cardiac power output, Diastolic function, Heart failure, Left ventricular geometry

Research Articles

Downloads

How to Cite

Taufiqurrahman, Heriansyah, T., Purnawarman, A., Novita, & Zulkarnain. (2025). ARNI vs ACE Inhibitors in Improving Left Ventricular Geometry, Diastolic Function, and Cardiac Power Output in HFrEF Patients: A Prospective Cohort Study among Acehnese, Indonesia. Jurnal Penelitian Pendidikan IPA, 11(4), 48–56. https://doi.org/10.29303/jppipa.v11i4.10593
Crossref
Scopus
Google Scholar
Europe PMC

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a condition associated with high morbidity and mortality. Changes in left ventricular geometry, diastolic function, and cardiac power output (CPO) are key indicators in the management of heart failure. ARNI and ACE inhibitors have been proven effective to treat this condition, but comparative studies on these therapies in the Asian population remain limited. This study was conducted to assess changes in left ventricular geometry, diastolic function, and CPO in heart failure patients following ARNI therapy compared to ACE inhibitors among Indonesian. This observational study employed a prospective cohort design involving 73 heart failure patients divided into two groups: the ARNI group and the ACE inhibitor group. Evaluations were conducted at first admission/recruitment and after three months period of therapy using echocardiography to assess parameters of left ventricular geometry (LVMI and RWT), diastolic function (E/e' ratio), and CPO. The use of ARNI or ACE inhibitors over three months showed a significant reduction in LVMI, accompanied by an improvement in diastolic function marked by a significant decrease in the E/e' ratio (p < 0.05). However, no significant differences were observed between the two groups. CPO values increased in both groups with a p-value < 0.05, where ARNI therapy showed a greater improvement compared to ACE inhibitors (p = 0.048). The use of ARNI and ACE inhibitors in heart failure patients can improve CPO, left ventricular geometry, and diastolic function, with ARNI therapy providing a better enhancement in CPO compared to ACE inhibitors.

References

Bangalore, S., Fakheri, R., Toklu, B., Ogedegbe, G., Weintraub, H., & Messerli, F. H. (2016). Angiotensin-Concerting Enzyme Inhibitors or Angiotensin Recetor Blockers in Patients Without Heart Failure? Insights From 254,301 Patients From Randomized Trials. Mayo Clinic Proceedings, 91(1), 51-60. https://doi.org/10.1016/j.mayocp.2015.10.019

Beck, A. L., Otto, M. E., Luciana, B. D., Netto, F. M., Armendaris, M. K., & Sposito, A. C. (2012). Diastolic function parameters are improved by the addition of simvastatin to enalapril-based treatment in hypertensive individuals. Atherosclerosis, 222(2), 444-448. https://doi.org/10.1016/j.atherosclerosis.2012.03.030

Brilla, C. G., Funck, R. C., & Rupp, H. (2000). Lisinopril-Mediated Regression of Myocardial Fibrosis in Patients with Hypertensive Heart Disease. Circulation, 102(12), 1388-1393. https://doi.org/10.1161/01.CIR.102.12.1388

Cheng, J., Zhang, W., Zhang, X., Han, F., Li, X., He, X., Li, Q., & Chen, J. (2014). Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Internal Medicine, 174(5), 773-785. https://doi.org/10.1001/jamainternmed.2014.348

Cikes, M., & Solomon, S. D. (2016). Beyond Ejection Fraction: an Integrative Approach for Assessment of Cardiac Structure and Function in Heart Failure. European Heart Journal, 37(21), 1642-1650. https://doi.org/10.1093/eurheartj/ehv510

Dowling, R., Melton, N.L., & Soleimani, B. (2020). Developments in Heart Failure with Reduced Ejection Fraction. Jama, 324(21), 2214-2215. https://doi.org/10.1001/JAMA.2020.20542

Elshafey, W. E. H., Khoufi, E. A. A., & Elmelegy, E. K. (2021). Effects of Sacubitril/Valsartan Treatment on Left Ventricular Myocardial Torsion Mechanics in Patients with Heart Failure Reduced Ejection Fraction 2D Speckle Tracking Echocardiography. Journal Cardiovasc Echogr, 31(2), 59-67. https://doi.org/10.4103/jcecho.jcecho_118_20

Erdogan, B. R., Yesilyurt-Dirican, Z. E., Karaomerlioglu, I., Muderrisoglu, A. E., Sevim, K., Michel, M. C., & Arioglu-Inan, E. (2024). Sacubitril/Valsartan Combination Partially Improves Cardiac Systolic, but Not Diastolic, Function through β-AR Responsiveness in a Rat Model of Type 2 Diabetes. International Journal of Molecular Sciences, 25(19), 10617. https://doi.org/10.3390/ijms251910617

Febiani, I., Pugliese, N. R., Pedrizzetti, G., Tonti, G., Castiglione, V., Chubuchny, V., Taddei, C., Gimelli, A., Punta, L. D., Balletti, A., Franco, A. D., Masi, S., Lombardi, C. M., Cameli, M., Emdin, M., & Giannoni, A. (2023). Haemodynamic Forces Predicting Remodelling and Outcome in Patients With Heart Failure Treated With Sacubitril/Valsartan. ESC Heart Fail, 10(5), 2927-2938. https://doi.org/10.1002/ehf2.14346

Gentile, P., Cantone, R., Perna, E., Ammirati, E., Varrenti, M., D'Angelo, L., Verde, A., Foti, G., Masciocco, G., Garascia, A., Frigerio, M., & Cipriani, M. (2022). Haemodynamic effects of sacubitril/valsartan in advanced heart failure. ESC Heart Fail, 9(2), 894-904. https://doi.org/10.1002/ehf2.13755

Gohar, A., Kievit, R. F., Valstar, G. B., Hoes, A. W., Riet, E. E. V., Mourik, Y. V., Bertens, L. C., Boonman-Winter, L. J., Bots, M. L., Ruijter, H. M. D., & Rutten, F. H. (2019). Opportunistic Screening Models for High-risk Men and Women to Detect Diasolic Dysfunction and Heart Failure With Preserved Ejection Fraction in the Community. European Journal of Preventive Cardiology, 26(6), 613-623. https://doi.org/10.1177/2047487318816774

Gøtzsche, C. O., Søgaard, P., Ravkilde, J., & Thygesen, K. (1992). Effects of captopril on left ventricular systolic and diastolic function after acute myocardial infarction. The American journal of cardiology, 70(2), 156-160. https://doi.org/10.1016/0002-9149(92)91268-9

Greenberg, B. H. (2002). Effects of angiotensin converting enzyme inhibitors on remodeling in clinical trials. Journal of cardiac failure, 8(6), S486-S490. https://doi.org/10.1054/jcaf.2002.129251

Harada, T., Yamaguchi, M., Omote, K., Iwano, H., Mizuguchi, Y., Amanai, S., Yoshida, K., Kato, T., Kurosawa, K., Nagai, T., Negishi, K., Anzai, T., & Obokata, M. (2022). Cardiac power output is independently and incrementally associated with adverse outcomes in heart failure with preserved ejection fraction. Circulation: Cardiovascular Imaging, 15(2). https://doi.org/10.1161./circimaging.121.013495

Haydock, P. M., & Flett, A. S. (2022). Management of heart failure with reduced ejection fraction. Heart, 108(19), 1571-1579. https://doi.org/10.1136/heartjnl-2020-318811

Hayley, B. D., & Burwash, I. G. (2012). Heart Failure With Normal Left Ventricular Ejection Fraction Role of Echocardiography. Cyrrent Opinion in Cardiology, 27(2), 169-180. https://doi.org/10.1097/HCO.0b013e32834fe8df

Heriansyah, T., Lestari, N. D., Hadi, T. F., Novia, R., Munawarah, I., Taufiqurrahman, T., Yuvhendmindo, S. L., & Bashori, A. A. (2024). ACE Inhibitors versus Angiotensin Receptor-Neprilysin Inhibitors for HFrEF Management: A Prospective Cohort Study from Indonesia. Narra Journal, 4(3), 978. http://doi.org/10.52225/narra.v4i3.978

Kaplansky, E. (2015). Paradigm-HF Trial: Will LCZ696 Change the Current Treatment of Systolic Heart Failure? Journal of Geriatric Cardiology, 12(5), 470-473. http://doi.org/10.11919.j.issn.1671-5411.2015.05.010

Kourek, C., Briasoulis, A., Papamichail, A., Xanthopoulus, A., Tsougos, E., Farmakis, D., & Paraskevaidis, I. (2024). Beyond Quadruple Therapy and Current Therapeutic Strategies in Heart Failure with Reduced Ejection Fraction: Medical Therapies with Potential to Become Part of the Therapeutic Armamentarium. International Journal of Molecular Sciences, 25(6), 3113. https://doi.org/10.3390/ijms25063113

Li, J., Song, Y., & Chen, F. (2024). Evaluating the Impact of Scubitil/Valsartan on Diastolic Funtion in Patients With Heart Failure: A Systematic Review and Meta-analysis. Medicine, 103(19). https://doi.org/10.1097/MD.0000000000037965

Mantegazza, V., Volpato, V., Mapelli, M., Sassi, V., Salvioni, E., Mattevelli, I., Tamorini, G., Agostoni, P., & Pepi, M. (2021). Cardiac Reverse Remodelling by 2D and 3D Echocardiography in Heart Failure Patients Treated with Sacubitril/Valsartan. Diagnostics, 11(10), 1845. https://doi.org/10.3390/diagnostics11101845

Martens, P., Belien, H., Dupont, M., Vandervoort, P., & Mullens, W. (2018). The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction. Cardiovasc Ther, 36(8). https://doi.org/10.1111/1755-5922.12435

Mcmurray, J. J. V., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., Rouleau, J. L., Shi, V. C., Solomon, S. D., Swedberg, K., & Zile, M. R. (2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. New England Journal of Medicine, 371(11), 993-1004. https://doi.org/10.1056/NEJMoa1409077

Murphy, S. P., Ibrahim, N. E., & Januzzi, J. L. (2020). Heart Failure with Reduced Ejection Fraction: A Review. Jama, 324(5), 488-504. https://doi.org/10.1001/jama.2020.10262

Monosilio, S., Filomena, D., Luongo, F., Sannino, M., Cimino, S., Neccia, M., Mariani, M.V., Birtolo, L. I., Benedetti, G., Tonti, G., Pedrizzetti, G., Vizza, C. D., Maestrini, V., & Agati, L. (2022). Cardiac and Vascular Remodeling After 6 Months of Therapy with Sacubitril/Valsartan: Mechanistic Insights from Advanced Echocardiographic Analysis. Front Cardiovasc Med, 9(4). https://doi.org/10.3389/fcvm.2022.883769

Nauli, S. E., Putri, V. K. P., Arifianto, H., Prameswari, H. S., Lubis, A. C., Zulkarnain, E., Hasanah, D. Y., Yamin, P. P. D., Dewi, T. I., & Irnizarifka, I. (2023). Heart Failure with Preserved Ejection Fraction: Current Status of Daily Clinical Practice in Indonesia. Cureus, 15(4). https://doi.org/10.7759/cureus.38086.

Oyanguren, J., Garcia-Garrido, L., Nebot, M., & Latorre-Garcia, P. (2020). Noninferiory of Heart Failure Nurse Titration Versus Heart Failure Cardiologist Titration. ETIFAC Multicenter Randomized Trial. Revista Espanola de Cardiologia, 74(6). https://doi.org/10.1016/j.rec.2020.04.016

Pericas, P., Mas-Llado, C., Ramis-Barcelo, M. F., Valadron, I., Mora, M. N., Marquez, L. P., Calino, R. G., Alberti, J. F. F., Disdier, V. P., & Rossello, X. (2021). Impact of Sacubitril–Valsartan Treatment on Diastolic Function in Patients with Heart Failure and Reduced Ejection Fraction. High Blood Pressure & Cardiovascular Prevention, 28(2), 167-175. https://doi.org/10. 1007/s40292-021-00437

Rashid, A. M., Khan, M. S., Fudim, M., DeWald, T. A., DeVore, A., & Butler, J. (2023). Management of heart failure with reduced ejection fraction. Current Problems in Cardiology, 48(5), 101596. https://doi.org/10.1016/j.cpcardjol.2023.101596

Tai, C., Gan, T., Zou, Y., Zhang, Y., Sun, Y., Chen, W., Li, J., Zhang, J., Xu, Y., Lu, H., & Xu, D. (2017). Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular events in patients with heart failure: a meta-analysis of randomized controlled trials. BMC Cardiovascular Disorders, 17(1), 275. https://doi.org/10.1186/s12872-017-0686-z

Tam, J. C. W., Cheng, F. W. T., & So, A. I. Y. (2023). Mortality and Hospitalization Rate of Heart Failure Patients with Prreserved Ejection Fraction Treated with Dapagliflozin VS. Empagliflozin. Research in Clinical Pharmacy, 1(2), 127-136. https://doi.org/10.59931/crp.23.0001

Taufik, M., Rizal, S., Harnelly, E., Muhammad, S., Syahrizal, D., Prajaputra, V., & Isnaini, N. (2024). The Therapeutic Potential of Aceh Patchouli Oil (Pogostemon cablin Benth.) in Enhancing Full-Thickness Wound Healing in Mice. Tropical Journal of Natural Product Research, 8(1), 5840-5844. https://doi.org/10.26538/tjnpr/v8i1.19

Turgeon, R. D., & Barry, A. R. (2020). Developments in Heart Failure With Reduced Ejection. JAMA, 324(21), 2215. https://doi.org/10.1001/jama.2020.20545

Williams, R., Donald, R., James, A., & Schiavone, E. (2022). Evaluation of a prescribing pharmacist-led heart failure (HF) up-titration clinic. European Heart Journal, 43(2), 1035. https://doi.org/10.1093/eurheartj/ehac544.1035

Sanderson, J. E., & Fraser, A. G. (2006). Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements. Progress in cardiovascular diseases, 49(3), 196-206. https://doi.org/10.1016/j.pcad.2006.08.005

Stokes, M. B., & Sanders, P. (2019). Does Left Ventricular Systolic Function Matter? Treating Atrial Fibrillation in HFrEF Versus HFpEF. Cardiol Clin, 37(2), 157-166. https://doi.org/10.1016/j.ccl.2019.01.008

Shah, A. M., Cikes, M., Prasad, N., Li, G., Getchevski, S., Claggett, B., Rizkla, A., Lukashevich, I., O'meara, E., Ryan, J., Shah, J., Mullens, W., Zile, M. R., Lam, C. S. P., Mcmurray, J. J. V., & Solomon, S. D. (2019). Echocardiographic Features of Patients With Heart Failure and Preserved Left Ventricular Ejection Failure. Journal Coll Cardiol, 74(23), 2858-2873. https://doi.org/10.1016/j.jacc.2019.09.063

Smith, K. V., Dunning. J. R., Fischer, C. M., & Maclean, T. (2021). Evaluation of the Usage and Dosing of Guideline-Directed Medical Trapy for Heart Failure With Reduced Ejection Fraction Patients in Clinical Practice. Journal of Pharmacy Practice, 35(5). https://doi.org/10.1177/089719002114840

Zhang, J., Du, L., Qin, X., & Guo, X. (2022). Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis of Observation Studies. Journal ofthe American Heart Association, 11(9). https://doi.org/10.1161/JAHA.121.024449

Zou, Z., Yuan, H. B., Yang, B., Xu, F., Chen, X. Y., Liu, G. J., & Shi, X. Y. (2016). Perioperative angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults. Cochrane Database System Review, 27(1). https://doi.org/10.1002/14651858.CD009210.pub.2

Author Biographies

Taufiqurrahman, Universitas Syiah Kuala

Teuku Heriansyah, Universitas Syiah Kuala

Adi Purnawarman, Universitas Syiah Kuala

Novita, Universitas Syiah Kuala

Zulkarnain, Universitas Syiah Kuala

License

Copyright (c) 2025 Taufiqurrahman, Teuku Heriansyah, Adi Purnawarman, Novita, Zulkarnain

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with Jurnal Penelitian Pendidikan IPA, agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC-BY License). This license allows authors to use all articles, data sets, graphics, and appendices in data mining applications, search engines, web sites, blogs, and other platforms by providing an appropriate reference. The journal allows the author(s) to hold the copyright without restrictions and will retain publishing rights without restrictions.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Jurnal Penelitian Pendidikan IPA.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).