{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:10:18Z","timestamp":1791670218755,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Angiotensin-converting enzyme inhibitors attenuate left ventricular (LV) enlargement after acute myocardial infarction (AMI). Preclinical data suggest similar benefits with combined angiotensin receptor neprilysin inhibition, but human data are conflicting. The PARADISE-MI Echo Study (Prospective ARNI Versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After Myocardial Infarction) tested the effect of sacubitril\/valsartan compared with ramipril on LV function and adverse remodeling after high risk-AMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In a prespecified substudy, 544 PARADISE-MI participants were enrolled in the Echo Study to undergo protocol echocardiography at randomization and after 8 months. Patients were randomized within 0.5 to 7 days of presentation with their index AMI to receive a target dose of sacubitril\/valsartan 200 mg or ramipril 5 mg twice daily. Echocardiographic measures were performed at a core laboratory by investigators blinded to treatment assignment. The effect of treatment on change in echo measures was assessed with ANCOVA with adjustment for baseline value and enrollment region. The primary end points were change in LV ejection fraction (LVEF) and left atrial volume (LAV), and prespecified secondary end points included changes in LV end-diastolic and end-systolic volumes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean age was 64\u00b112 years; 26% were women; mean LVEF was 42\u00b112%; and LAV was 49\u00b117 mL. Of 544 enrolled patients, 457 (84%) had a follow-up echo at 8 months (228 taking sacubitril\/valsartan, 229 taking ramipril). There was no significant difference in change in LVEF (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.79) or LAV (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.62) by treatment group. Patients randomized to sacubitril\/valsartan demonstrated less increase in LV end-diastolic volume (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.025) and greater decline in LV mass index (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.037), increase in tissue Doppler e\u2019\n                      <jats:sub>lat<\/jats:sub>\n                      (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005), decrease in E\/e\u2019\n                      <jats:sub>lat<\/jats:sub>\n                      (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.045), and decrease in tricuspid regurgitation peak velocity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.024) than patients randomized to ramipril. These differences remained significant after adjustment for differences in baseline characteristics. Baseline LVEF, LV end-diastolic volume, LV end-systolic volume, LV mass index, LAV, and Doppler-based diastolic indices were associated with risk of cardiovascular death or incident heart failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Treatment with sacubitril\/valsartan compared with ramipril after AMI did not result in changes in LVEF or LAV at 8 months. Patients randomized to sacubitril\/valsartan had less LV enlargement and greater improvement in filling pressure. Measures of LV size, systolic function, and diastolic properties were predictive of cardiovascular death and incident heart failure after AMI in this contemporary, well-treated cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02924727.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.059210","type":"journal-article","created":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T14:00:55Z","timestamp":1664805655000},"page":"1067-1081","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Impact of Sacubitril\/Valsartan Compared With Ramipril on Cardiac Structure and Function After Acute Myocardial Infarction: The PARADISE-MI Echocardiographic Substudy"],"prefix":"10.1161","volume":"146","clinical-trial-number":[{"clinical-trial-number":"nct02924727","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1056-4451","authenticated-orcid":true,"given":"Amil M.","family":"Shah","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, MA (A.M.S., B.C., N.P., G.L., M.V., K.J., S.D.S, 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Hospital, Boston, MA (A.M.S., B.C., N.P., G.L., M.V., K.J., S.D.S, M.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra","family":"Volquez","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, MA (A.M.S., B.C., N.P., G.L., M.V., K.J., S.D.S, M.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5243-1959","authenticated-orcid":true,"given":"Karola","family":"Jering","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, MA (A.M.S., B.C., N.P., G.L., M.V., K.J., S.D.S, M.A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4772-5549","authenticated-orcid":true,"given":"Maja","family":"Cikes","sequence":"additional","affiliation":[{"name":"University of Zagreb School of Medicine and University Hospital Centre Zagreb, 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