Caspian Journal of Internal Medicine

en Efficacy of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Right Ventricular Failure and preserved LV Ejection Fraction: A Systematic Review and Meta-Analysis Cardiology Cardiology Review Article Review Article Background: Right ventricular (RV) failure with preserved left ventricular (LV) ejection fraction (LVEF ≥50%) is a distinct clinical entity often associated with pulmonary hypertension (PH), chronic lung diseases, or congenital heart defects, leading to significant morbidity and mortality. Angiotensin receptor neprilysin inhibitors (ARNI), such as sacubitril/valsartan, have demonstrated efficacy in left-sided heart failure, but their role in isolated RV failure remains understudied. Methods: A PRISMA-compliant search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar was conducted from 2010 to 2025 for RCTs and prospective cohorts assessing ARNI in patients with RV failure and preserved LVEF. Inclusion: Adults with RV dysfunction (e.g., TAPSE <17 mm or RV S' <9.5 cm/s) and LVEF ≥50%; ARNI vs. standard care or pre-treatment; reporting RV parameters, sPAP, NT-proBNP, 6MWD, or NYHA class. Results: Three studies (1 RCT, 2 prospective cohorts; n=120 patients) were included. ARNI improved TAPSE (WMD 1.2 mm, 95% CI 0.7-1.7; p<0.001; I²=0%), RV S' (WMD 0.5 cm/s, 95% CI 0.2-0.8; p=0.002; I²=0%), and reduced sPAP (WMD -7.5 mmHg, 95% CI -10.2 to -4.8; p<0.001; I²=15%). NT-proBNP decreased (WMD -1200 pg/mL, 95% CI -1700 to -700; p<0.001; I²=0%). 6MWD increased (WMD 30 m, 95% CI 10-50; p=0.003; I²=0%). NYHA class improved (RR 1.65 for ≥1 class improvement, 95% CI 1.15-2.37; p=0.007; I²=0%). Conclusions: ARNI enhances RV function, reduces pulmonary pressures, and improves functional status in RV failure with preserved LVEF.   ARNI, sacubitril/valsartan, right ventricular failure, preserved LVEF, pulmonary hypertension 3 0 http://caspjim.com/browse.php?a_code=A-10-3855-4&slc_lang=en&sid=1 Mohsen Safari mohsensafari.medicine@gmail.com 100319475328460057093 100319475328460057093 Yes Department of Cardiovascular Medicine Zeinab Safari mohsen_888s@yahoo.com 100319475328460057094 100319475328460057094 No Department of Cardiovascular Medicine