ARNI, Not used for HFmrEF (EF 41 ~ 49%)

EF < 40 %           - HFrEF
EF > 50 %           - HFpEF
EF 41 % ~ 49% - HFmrEF

Nearly half of patients with HF have an LVEF ≤ 40 percent (HF with reduced LVEF [HFrEF]), and nearly half have an LVEF ≥ 50 percent (HF with preserved LVEF [HFpEF]). The remaining 10 to 24 percent of patients with HF present with an LVEF falling in the intermediate range (41 to 49 percent) between these two extremes.


유효한 증거에 따르면, 우리는 HFmrEF를 치료하기 위해  ARNI를 사용하지 않습니다. HFrEF 환자의 PARADIGM 시험에서 ARNI 치료는 HF의 사망 및 입원 위험을 줄이는데 ACE 억제제인 에날라프릴보다 우월했지만 LVEF가 40 % 이상인 환자는 제외되었습니다. HF 및 LVEF가 45 % 이상인 환자를 대상으로 한 phase 2 study에서 ARNI 치료법은 ARB valsartan에 비해  surrogate marker인 N-terminal pro-brain natriuretic peptide level을 감소시켰지만  outcome data는 이 코호트에서 부족했습니다. ARNI의 효능과 안전성은 HF와 LVEF가 45 % 이상인 환자의 임상 시험에서 현재 테스트 중이며, 이것은 이 문제를 해결하는 데 도움이 될 것입니다.

REF. UpToDate 2018.08.20