A separately reported study for sacubitril valsartan found that a reduction in NT-proBNP concentration with therapy was weakly yet significantly correlated with improvements in markers of cardiac volume and function at 12 months
A related commentary discusses these two papers. It states that there has been an evidence gap in the data assessing how Angiotensin Receptor–Neprilysin Inhibition (ARNI) improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF), and that the data from these studies may substantially advance current understanding. These data strongly suggest that ARNI therapy can promote cardiac reverse remodeling in patients with HFrEF. Although neither investigation assessed this question as its primary end point, and one study was observational in nature, the replication of the reduction in left ventricular volumes and left atrial volumes in these reports, as well as the large, progressive increase in left ventricular ejection fraction in PROVE-HF, are important. As with β-blockers and ACE inhibitors, it thus appears that the benefits of ARNI therapy on clinical outcomes in patients with HFrEF are mediated, at least in part, by their favourable effects on the adverse cardiac remodeling that characterizes this condition.