Top

Published in:

01-05-2020 | Valsartan | Original Paper

ARNIs: balancing “the good and the bad” of neuroendocrine response to HF

Authors: Roberto Ferrari, J. Cardoso, M. C. Fonseca, C. Aguiar, J. I. Moreira, A. Fucili, C. Rapezzi, the “Italian-Portuguese Action on Heart Failure” Group

Published in: Clinical Research in Cardiology | Issue 5/2020

Abstract

Background

A new class of drugs—angiotensin receptor, neprylisin inhibitors, ARNI—has shown to be prognostic superior in HFrEF to the sole inhibition of the renin–angiotensin axes with enalapril. The ultimate mechanism of action of ARNIs is unknown.

Aim

We have considered that ARNI exerts a positive modulation of the neuroendocrine balance, with enhancement of the physiological diuresis and dilatation due to neprylisin inhibition by sacubitril. This represents a shift in HF medical therapy always directed to counteract (with inhibitors of the renin–angiotensin system, beta blockers or inhibitors of aldosterone) the so-called “bad” neuroendocrine response. Development of ARNI, on the contrary, has led to consider the neuroendocrine response to HFrEF from a different angle, which is to say that the activation is not always deleterious, but it could also be beneficial. This concept is highlighted by the enhancement of the activity of atrial natriuretic peptide, induced by sacubitril/valsartan in the PARADIGM trial, and found as proof from early studies on untreated patients with constrictive pericarditis. The possibility that sacubitril inhibition of neprylisin acts by enhancing substance P and gene-related calcitonin peptide is also considered, as well as the negative effect of neprylisin inhibition.

Conclusions

The beneficial effects of ARNI are related, in part at least, to a positive modulation of the neuroendocrine response to the disease, resulting in an increase of physiological diuresis and dilatation.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128 CrossRefPubMed

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol 70(6):776–803. https://doi.org/10.1016/j.jacc.2017.04.025 CrossRefPubMed

Jobs A, Abdin A, de Waha-Thiele S, Eitel I, Thiele H, de Wit C, Vonthein R (2019) Angiotensin-converting-enzyme inhibitors in hemodynamic congestion: a meta-analysis of early studies. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01456-4. (Epub ahead of print] (PMID: 30895374))

Ohtani K, Ide T, Hiasa KI, Sakamoto I, Yamashita N, Kubo M, Tsutsui H (2019) Cardioprotective effect of renin-angiotensin inhibitors and β-blockers in trastuzumab-related cardiotoxicity. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01448-4. ([Epub ahead of print] PMID: 30859381)

Packer M (1992) Pathophysiology of chronic heart failure. Lancet (Lond Engl) 340(8811):88–92CrossRef

McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, PARADIGM-HF Investigators Committees (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371(11):993–1004. https://doi.org/10.1056/NEJMoa1409077 CrossRefPubMed

Martens P, Nuyens D, Rivero-Ayerza M, Van Herendael H, Vercammen J, Ceyssens W, Luwel E, Dupont M, Mullens W (2019) Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01440-y. ([Epub ahead of print] (PMID: 30788621))

Seferovic JP, Claggett B, Seidelmann SB, Seely EW, Packer M, Zile MR, Rouleau JL, Swedberg K, Lefkowitz M, Shi VC, Desai AS, McMurray JJV, Solomon SD (2017) Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post-hoc analysis from the PARADIGM-HF trial. Lancet Diabetes Endocrinol 5(5):333–340. https://doi.org/10.1016/S2213-8587(17)30087-6 CrossRefPubMedPubMedCentral

Jhund PS, Fu M, Bayram E, Chen C-H, Negrusz-Kawecka M, Rosenthal A, Desai AS, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR, McMurray JJV, Packer M, PARADIGM-HF Investigators Committees (2015) Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: insights from PARADIGM-HF. Eur Heart J 36(38):2576–2584. https://doi.org/10.1093/eurheartj/ehv330 CrossRefPubMedPubMedCentral

10.

Damman K, Gori M, Claggett B, Jhund PS, Senni M, Lefkowitz MP, Prescott MF, Shi VC, Rouleau JL, Swedberg K, Zile MR, Packer M, Desai AS, Solomon SD, McMurray JJV (2018) Renal effects and associated outcomes during angiotensin-neprilysin inhibition in heart failure. JACC Heart Fail 6(6):489–498. https://doi.org/10.1016/j.jchf.2018.02.004 CrossRefPubMed

11.

Packer M, Claggett B, Lefkowitz MP, McMurray JJV, Rouleau JL, Solomon SD, Zile MR (2018) Effect of neprilysin inhibition on renal function in patients with type 2 diabetes and chronic heart failure who are receiving target doses of inhibitors of the renin-angiotensin system: a secondary analysis of the PARADIGM-HF trial. Lancet Diabetes Endocrinol 6(7):547–554. https://doi.org/10.1016/S2213-8587(18)30100-1 CrossRefPubMed

12.

Senni M, McMurray JJV, Wachter R, McIntyre HF, Reyes A, Majercak I, Andreka P, Shehova-Yankova N, Anand I, Yilmaz MB, Gogia H, Martinez-Selles M, Fischer S, Zilahi Z, Cosmi F, Gelev V, Galve E, Gómez-Doblas JJ, Nociar J, Radomska M, Sokolova B, Volterrani M, Sarkar A, Reimund B, Chen F, Charney A (2016) Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomized comparison of two uptitration regimens. Eur J Heart Fail 18(9):1193–1202. https://doi.org/10.1002/ejhf.548 CrossRefPubMed

13.

Wachter R, Senni M, Belohlavek J, Butylin D, Noe A, Pascual-Figal D (2018) P886 initiation of sacubitril/valsartan in hospitalized patients with heart failure with reduced ejection fraction after hemodynamic stabilisation: primary results of the TRANSITION study. Eur Heart J 39:ehy564–886

14.

Velazquez EJ, Morrow DA, DeVore AD, Duffy CI, Ambrosy AP, McCague K, Rocha R, Braunwald E, Investigators PIONEER-HF (2019) Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med 380(6):539–548. https://doi.org/10.1056/NEJMoa1812851 CrossRefPubMed

15.

McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau J, Shi VC, Solomon SD, Swedberg K, Zile MR, PARADIGM-HF Committees Investigators (2013) Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail 15(9):1062–1073. https://doi.org/10.1093/eurjhf/hft052 CrossRefPubMedPubMedCentral

16.

Bayes-Genis A, Barallat J, Richards AM (2016) A test in context: Neprylisin. Function, inhibition, and biomarker J Am Coll Cardiol 68(6):639–653. https://doi.org/10.1016/j.jacc.2016.04.060 CrossRefPubMed

17.

Potter LR (2011) Natriuretic peptide metabolism, clearance and degradation. FEBS J 278(11):1808–1817. https://doi.org/10.1111/j.1742-4658.2011.08082.x CrossRefPubMedPubMedCentral

18.

Lainchbury JG, Nicholls MG, Espiner EA, Ikram H, Yandle TG, Richards AM (1998) Regional plasma levels of cardiac peptides and their response to acute neutral endopeptidase inhibition in man. Clin Sci (Lond) 95(5):547–555CrossRef

19.

Smith MW, Espiner EA, Yandle TG, Charles CJ, Richards AM (2000) Delayed metabolism of human brain natriuretic peptide reflects resistance to neutral endopeptidase. J Endocrinol 167(2):239–246CrossRefPubMed

20.

Belenky A, Smith A, Zhang B, Lin S, Despres N, Wu AH, Bluestein BI (2004) The effect of class-specific protease inhibitors on the stabilization of B-type natriuretic peptide in human plasma. Clin Chim Acta 340(1–2):163–172CrossRefPubMed

21.

Ferrari R (2014) Coronary artery disease: use of ACE inhibitors in stable CAD—what is the truth? Nature Rev Cardiol 11(6):315–316CrossRef

22.

Ferrari R, Ceconi C (2012) Landmark Trials: PERTINENT Cardiovasc Res 96(2):204–207

23.

Packer M, Califf RM, Konstam MA, Krum H, McMurray JJ, Rouleau JL, Swedberg K (2002) Comparison of omapatrilat and enalapril in patients with chronic heart failure: the omapatrilat versus enalapril randomized trial of utility in reducing events (OVERTURE). Circulation 106(8):920–926CrossRefPubMed

24.

Messerli FH, Nussberger J (2000) Vasopeptidase inhibition and angio-oedema. Lancet 356(9230):608–609CrossRefPubMed

25.

Mulderry PK, Ghatei MA, Rodrigo J, Allen JM, Rosenfeld MG, Polak JM, Bloom SR (1985) Calcitonin gene-related peptide in cardiovascular tissues of the rat. Neuroscience 14(3):947–954CrossRefPubMed

26.

Hanko J, Hardebo JE, Kahrstrom J, Owman C, Sandler F (1985) Calcitonin gene-related peptide is present in mammalian cerebrovascular nerve fibers and dilates pial and peripheral arteries. Neurosci Lett 57(1):91–95CrossRefPubMed

27.

Agnoletti G, Cornacchiari A, Panzali AF, Ghielmi S, De Giuli F, Ferrari R (1990) Effect of congestive heart failure on rate of atrial natriuretic factor release in response to stretch and isoprenaline. Cardiovasc Res 24(11):938–945CrossRefPubMed

28.

Anand IS, Gurden J, Wander GS, O’Gara P, Harding SE, Ferrari R, Cornacchiari A, Panzali A, Wahi PL, Poole-Wilson PA (1991) Cardiovascular and hormonal effects of calcitonin gene-related peptide in congestive heart failure. J Am Coll Cardiol 17(1):208–217CrossRefPubMed

29.

Ona K, Delay M, Nakajima T, Irisawa H, Giles W (1989) Calcitonin generated peptide regulates calcium current in heart muscle. Nature 340(6236):721–724CrossRef

30.

Nadel JA, Borson DB (1991) Modulation of neurogenic inflammation by neutral endopeptidase. Am Rev Respir Dis 143(3 Pt 2):S33–36CrossRefPubMed

31.

Spillantini MG, Sicuteri F, Salmon S, Malfroy B (1990) Characterization of endopeptidase 3.4.24.11 (“enkephalinase”) activity in human plasma and cerebrospinal fluid. Biochem Pharmacol 39(8):1353–1356

32.

Roques BP, Noble F, Daugé V, Fournié-Zaluski MC, Beaumont A (1993) Neutral endopeptidase 24.11: structure, inhibition, and experimental and clinical pharmacology. Pharmacol Rev 45(1):87–146

33.

Vodovar N, Paquet C, Mebazaa A, Launay JM, Hugon J, Cohen-Solal A (2015) Neprilysin, cardiovascular, and Alzheimer’s diseases: the therapeutic split? Eur Heart J 36(15):902–905. https://doi.org/10.1093/eurheartj/ehv015 CrossRefPubMed

34.

Grimm MO, Mett J, Stahlmann CP, Haupenthal VJ, Zimmer VC, Hartmann T (2013) Neprilysin and Ab clearance: impact of the APP intracellular domain in NEP regulation and implications in Alzheimer’s disease. Front Aging Neurosci 5:98. https://doi.org/10.3389/fnagi.2013.00098 CrossRefPubMedPubMedCentral

35.

Eckman EA, Adams SK, Troendle FJ, Stodola BA, Kahn MA, Fauq AH, Xiao HD, Bernstein KE, Eckman CB (2006) Regulation of steady-state b-amyloid levels in the brain by neprilysin and endothelin-converting enzyme but not angiotensin-converting enzyme. J Biol Chem 281(41):30471–30478CrossRefPubMed

36.

Kirkwood KS, Bunnett NW, Maa J, Castagliolo I, Liu B, Gerard N, Zacks J, Pothoulakis C, Grady EF (2001) Deletion of neutral endopeptidase exacerbates intestinal inflammation induced by Clostridium difficile toxin A. Am J Physiol Gastrointest Liver Physiol 281(2):G544–G551CrossRefPubMed

37.

Lambert JC, Ibrahim-Verbaas CA, Harold D, Naj AC, Sims R, Bellenguez C, DeStafano AL, Bis JC, Beecham GW, Grenier-Boley B, Russo G, Thorton-Wells TA, Jones N, Smith AV, Chouraki V, Thomas C, Ikram MA, Zelenika D, Vardarajan BN, Kamatani Y, Lin CF, Gerrish A, Schmidt H, Kunkle B, Dunstan ML, Ruiz A, Bihoreau MT, Choi SH, Reitz C, Pasquier F, Cruchaga C, Craig D, Amin N, Berr C, Lopez OL, De Jager PL, Deramecourt V, Johnston JA, Evans D, Lovestone S, Letenneur L, Morón FJ, Rubinsztein DC, Eiriksdottir G, Sleegers K, Goate AM, Fiévet N, Huentelman MW, Gill M, Brown K, Kamboh MI, Keller L, Barberger-Gateau P, McGuiness B, Larson EB, Green R, Myers AJ, Dufouil C, Todd S, Wallon D, Love S, Rogaeva E, Gallacher J, St George-Hyslop P, Clarimon J, Lleo A, Bayer A, Tsuang DW, Yu L, Tsolaki M, Bossù P, Spalletta G, Proitsi P, Collinge J, Sorbi S, Sanchez-Garcia F, Fox NC, Hardy J, Deniz Naranjo MC, Bosco P, Clarke R, Brayne C, Galimberti D, Mancuso M, Matthews F (2013) European Alzheimer's Disease Initiative (EADI); Genetic and Environmental Risk in Alzheimer's Disease; Alzheimer's Disease Genetic Consortium; Cohorts for Heart and Aging Research in Genomic Epidemiology, Moebus S, Mecocci P, Del Zompo M, Maier W, Hampel H, Pilotto A, Bullido M, Panza F, Caffarra P, Nacmias B, Gilbert JR, Mayhaus M, Lannefelt L, Hakonarson H, Pichler S, Carrasquillo MM, Ingelsson M, Beekly D, Alvarez V, Zou F, Valladares O, Younkin SG, Coto E, Hamilton-Nelson KL, Gu W, Razquin C, Pastor P, Mateo I, Owen MJ, Faber KM, Jonsson PV, Combarros O, O'Donovan MC, Cantwell LB, Soininen H, Blacker D, Mead S, Mosley TH Jr, Bennett DA, Harris TB, Fratiglioni L, Holmes C, de Bruijn RF, Passmore P, Montine TJ, Bettens K, Rotter JI, Brice A, Morgan K, Foroud TM, Kukull WA, Hannequin D, Powell JF, Nalls MA, Ritchie K, Lunetta KL, Kauwe JS, Boerwinkle E, Riemenschneider M, Boada M, Hiltuenen M, Martin ER, Schmidt R, Rujescu D, Wang LS, Dartigues JF, Mayeux R, Tzourio C, Hofman A, Nöthen MM, Graff C, Psaty BM, Jones L, Haines JL, Holmans PA, Lathrop M, Pericak-Vance MA, Launer LJ, Farrer LA, van Duijn CM, Van Broeckhoven C, Moskvina V, Seshadri S, Williams J, Schellenberg GD, Amouyel P (2018) Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer’s disease. Nat Genet 45(12):1452–1458. https://doi.org/10.1038/ng.2802

38.

Maa J, Grady EF, Yoshimi SK, Drasin TE, Kim EH, Hutter MM, Bunnett NW, Kirkwood KS (2000) Substance P is a determinant of lethality in diet-induced hemorrhagic pancreatitis in mice. Surgery 128(2):232–239CrossRefPubMed

39.

Harris P (1988) Role of arterial pressure in the oedema of heart disease. Lancet 1(8593):1036–1038CrossRefPubMed

40.

Ferrari R, Ceconi C, Signorini C, Arnand I, Harris P, Albertini A (1989) Sample treatment for long-distance transport of plasma for hormone assay. Clin Chem 35(2):331–332CrossRefPubMed

41.

Stienen S, Rossignol P, Barros A, Girerd N, Pitt B, Zannad F, Ferreira JP (2019) Determinants of anti-fibrotic response to mineralocorticoid receptor antagonist therapy: insights from the Eplerenone post-acute myocardial infarction heart failure efficacy and survival study (EPHESUS) and early eplerenone treatment in patients with acute ST-elevation Myocardial Infarction without Heart Failure (REMINDER) trials. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01500-3. ([Epub ahead of print] (PMID: 31250134))

42.

Ferreira JP, Pizard A, Machu JL, Bresso E, Rocca HB, Girerd N, Leroy C, González A, Diez J, Heymans S, Devignes MD, Rossignol P, Zannad F (2019) Plasma protein biomarkers and their association with mutually exclusive cardiovascular phenotypes: the FIBRO-TARGETS case-control analyses. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01480-4. ([Epub ahead of print] (PMID: 31062082))

43.

Münzel T, Hahad O, Gori T, Hollmann S, Arnold N, Prochaska JH, Schulz A, Beutel M, Pfeiffer N, Schmidtmann I, Lackner KJ, Keaney JF, Wild PS (2019) Heart rate, mortality, and the relation with clinical and subclinical cardiovascular diseases: results from the Gutenberg Health Study. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01466-2. ([Epub ahead of print] PMID: 30953178)

44.

Anand IS, Ferrari R, Kalra GS, Wahi PL, Poole-Wilson PA, Harris P (1989) Edema of cardiac origin. Studies of body water and sodium, renal function, hemodynamic indexes, and plasma hormones in untreated congestive cardiac failure. Circulation 80(2):299–305

45.

Anand IS, Chandrashekhar Y, Ferrari R, Sarma R, Guleria R, Jindal SK, Wahi PL, Poole-Wilson PA, Harris PC (1992) Pathogenesis of the congestive state in chronic obstructive pulmonary disease: studies of body water and sociium, renal function, hemodynamics, and plasma hormones during edema and after recovery. Circulation 86(1):12–21CrossRefPubMed

46.

Agnoletti G, Rodella A, Ferrari R, Harris P (1987) Release of atrial natriuretic peptide-like immunoreactive material during stretchin of the rat atrium in vitro. J Mol Cell Cardiol 19(3):217–220CrossRefPubMed

47.

Ferrari R, Malagù M, Biscaglia S, Fucili A, Rizzo P (2016) Remodelling after an Infarct: crosstalk between life and death cardiology. Cardiology 135(2):68–76. https://doi.org/10.1159/000445882 CrossRefPubMed

48.

Packer M, McMurray JJ, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile M, Andersen K, Arango JL, Arnold JM, Bělohlávek J, Böhm M, Boytsov S, Burgess LJ, Cabrera W, Calvo C, Chen CH, Dukat A, Duarte YC, Erglis A, Fu M, Gomez E, Gonzàlez-Medina A, Hagège AA, Huang J, Katova T, Kiatchoosakun S, Kim KS, Kozan Ö, Llamas EB, Martinez F, Merkely B, Mendoza I, Mosterd A, Negrusz-Kawecka M, Peuhkurinen K, Ramires FJ, Refsgaard J, Rosenthal A, Senni M, Sibulo AS Jr, Silva-Cardoso J, Squire IB, Starling RC, Teerlink JR, Vanhaecke J, Vinereanu D, Wong RC, PARADIGM-HF Investigators Coordinators (2015) Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation 131(1):54–61. https://doi.org/10.1161/CIRCULATIONAHA.114.013748 CrossRefPubMed

49.

Anand IS, Ferrari R, Kalra GS, Wahi PL, Poole-Wilson PA, Harris PC (1991) Pathogenesis of edema in constrictive pericarditis: studies of body water and sodium, renal function, hemodynamics and plasma hormones before and after pericardiectomy. Circulation 83(6):1880–1887CrossRefPubMed

50.

Leya FS, Arab D, Joyal D, Shioura KM, Lewis BE, Steen LH, Cho L (2005) The efficacy of brain natriuretic peptide levels in differentiating constrictive pericarditis from restrictive cardiomyopathy. J Am Coll Cardiol 45(11):1900–1902CrossRefPubMed

51.

Anand IS, Kalra GS, Ferrari R, Wahi PL, Poole-Wilson PA, Harris P (1989) Haemodynamic, hormonal, and renal effects of alpha-human ANP infusion in untreated congested heart failure. Am Heart J 118(3):500–505CrossRefPubMed

Title: ARNIs: balancing “the good and the bad” of neuroendocrine response to HF
Authors: Roberto Ferrari
J. Cardoso
M. C. Fonseca
C. Aguiar
J. I. Moreira
A. Fucili
C. Rapezzi
the “Italian-Portuguese Action on Heart Failure” Group
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keyword: Valsartan
Published in: Clinical Research in Cardiology / Issue 5/2020
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01547-2

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

At a glance: The STEP trials

Springer Medicine

ARNIs: balancing “the good and the bad” of neuroendocrine response to HF

Abstract

Background

Aim

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aim

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Periprocedural embolisation of a Sapien 3 TAVI prosthesis: failure and success

Correction to: Electromagnetic interference in implantable cardioverter defibrillators: present but rare

A comparison of procedural success rate and long-term clinical outcomes between in-stent restenosis chronic total occlusion and de novo chronic total occlusion using multicenter registry data

Adenosine stress perfusion cardiac magnetic resonance imaging in patients undergoing intracoronary bone marrow cell transfer after ST-elevation myocardial infarction: the BOOST-2 perfusion substudy

Catheter ablation in highly symptomatic Brugada patients: a Dutch case series

Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis utilizing the next-generation fully retrievable and repositionable valve system: mid-term results from a prospective multicentre registry

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page