Heart failure & cardiomyopathies
Association of angiotensin receptor-neprilysin inhibitor duration with latent remodeling following implantable cardioverter defibrillator implantation
Authors' conclusion
Shorter ARNI exposure before ICD implantation was independently associated with latent LVRR, highlighting the need for sufficient guideline-directed medical therapy to optimize reverse remodeling, whereas residual arrhythmic risk warrants continued ICD protection.
Study context
- Population
- Patients with nonischemic dilated cardiomyopathy (NIDCM) with LVEF of ≤35% and prior angiotensin receptor-neprilysin inhibitor (ARNI) treatment before primary prevention implantable cardioverter-defibrillator (ICD) implantationpatients with NIDCM (69.3% male, mean age 61 years)
- Participants
- Seventy-five patients
- Comparison
- the association between duration of pre-ICD ARNI therapy and latent left ventricular reverse remodeling (LVRR) in patients with NIDCM
- latent LVRRn = 22
Main finding
As reported in the abstract
Latent LVRR · 1 year
Latent LVRR
29.3%
22 of 22
Further findings
| Outcome | Odds ratio | P value |
|---|---|---|
| Predictors of latent LVRR — duration from heart failure diagnosis to ICD implant · Multivariable logistic regression | 0.88 | P = 0.007 |
| Predictors of latent LVRR — duration from ARNI initiation to ICD implant · Multivariable logistic regression | 0.90 | P = 0.029 |
- Predictors of latent LVRR: 4.8 vs 30.1 months; shorter duration independently associated with latent LVRR
- Predictors of latent LVRR: 2.3 vs 7.2 months; shorter duration independently associated with latent LVRR
Predictors of latent LVRR
- Conventional variables, including age, sex, QRS duration, heart rate, and late gadolinium enhancement burden, were not predictive
Cardiac magnetic resonance imaging fibrosis markers
- Uniformly elevated fibrosis markers across groups, with no difference observed in native T1, T2, extracellular volume, or late gadolinium enhancement
Safety
Ventricular arrhythmia incidence · median follow-up of 33.8 months
- Ventricular arrhythmia incidence was comparable
- 9.1% vs 7.5%
Original publication
Association of angiotensin receptor-neprilysin inhibitor duration with latent remodeling following implantable cardioverter defibrillator implantation. Heart Rhythm. Published 6 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it