Effect of sacubitril/valsartan and empagliflozin on systemic inflammation and scar remodeling in a swine model of myocardial infarction
Abstract
Angiotensin receptor neprilysin inhibitor (ARNI) and sodium glucose cotransporter 2 inhibitors (SGLT2i) lead to reduced cardiovascular death and hospitalization rates for heart failure, but mechanisms of action remain unclear.
To evaluate the effect of ARNI and SLGT2i on cardiac function, systemic inflammation and scar remodeling in a porcine model of acute myocardial infarction (MI).
Thirty-three pigs (18 female, 15 male) with non-revascularized MI were randomized to receive treatment with beta-blocker (BB) only (BB group, n=8), empagliflozin + BB (SGLT2i group, n=8), sacubitril/valsartan + BB (ARNI group, n=9) or empagliflozin + sacubitril/valsartan + BB (SGLT2i + ARNI group, n=8) for 30 days post-MI. Cardiac function parameters were studied at 2- and 30-days post-MI by cardiac magnetic resonance imaging. The systemic immune response was analysed at baseline, 2-, 15- and 30-days post-MI to estimate 1) the absolute number of neutrophils and lymphocytes by FSC-A/SSC-A, 2) the circulating monocytes (CD172a+) and their phenotype according to CD73+, and CCR2+ expression. Animals were euthanized at 30 days, interstitial collagen and vascular density of the scar were quantified.
Left ventricular ejection fraction (LVEF) and stoke volume (LVSV) improved in SGLT2i + ARNI group (P=0.02, P=0.002, respectively, 2 vs 30 days post-MI). Right ventricular ejection fraction (RVEF) and stroke volume (RVSV) improved in ARNI treatment arm (P=0.03; P=0.02, respectively, 2 vs 30 days post-MI).…
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