Heart failure & cardiomyopathiesResearch article
Association of angiotensin receptor-neprilysin inhibitor duration with latent remodeling following implantable cardioverter defibrillator implantation
- retrospectively analyzed
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:10.1016/j.hrthm.2026.07.044
Summarised from the published abstract; every number is checked against it