{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:42:47Z","timestamp":1777290167049,"version":"3.51.4"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to evaluate the effects of angiotensin receptor\u2013neprilysin inhibitor (ARNI) on myocardial energy metabolism and prognosis in patients with acute myocardial infarction (AMI) complicated by heart failure (HF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on data from 244 inpatients admitted to our center, who were diagnosed with AMI complicated by HF. Among these patients, 210 completed a 1-year follow-up. According to the use of angiotensin-converting enzyme inhibitors (ACEI)\/angiotensin receptor blockers (ARB)\/ARNI, the 210 patients were divided into the ARNI group (107 cases, 51.0%) and the non-ARNI (ACEI\/ARB) group (103 cases, 49.0%). The main outcome measures were the changes in myocardial energy expenditure (MEE) and prognostic indicators after 1-year follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ARNI significantly reduced MEE after 1 year compared with the ACEI\/ARB [(129.61\u2009\u00b1\u200940.81)\u2005kcal\/min vs. (154.49\u2009\u00b1\u200947.58)\u2005kcal\/min, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.01]. The MEE level in the HFrEF group was significantly higher than that in the HFmrEF group (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). The ARNI group showed significantly lower rates of heart failure (23.0% vs. 43.4%, <jats:italic>P<\/jats:italic>\u2009=\u20090.001), recurrent myocardial infarction (9.8% vs. 22.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.009), and renal function deterioration (5.7% vs. 13.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.049) than those in the non-ARNI group. ROC analysis identified an MEE (kcal\/min) cutoff value of 178, with 85% sensitivity and 64% specificity for the prediction of cardiac death (AUC\u2009=\u20090.74, <jats:italic>P<\/jats:italic>\u2009=\u20090.007). During the 1-year follow-up, patients with MEE over 178\u2005kcal\/min were associated with increased risk of all-cause death compared with those with MEE below 178\u2005kcal\/min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ARNI significantly reduced MEE compared with ACEI\/ARB. MEE was significantly associated with the severity of left ventricular systolic dysfunction and long-term prognosis. An MEE value over 178\u2005kcal\/min was a powerful predictor of cardiac death and linked with increased risk of 1-year all-cause mortality in patients with AMI complicated by HF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1550624","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T05:31:14Z","timestamp":1754976674000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of angiotensin receptor\u2013neprilysin inhibition on myocardial energy metabolism and prognosis in patients with acute myocardial infarction complicated by heart 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