Key result
Higher baseline wLVS linked to ~36% higher odds of response to sacubitril/valsartan.
Why the study?
A novel tool evaluating left ventricular systo-diastolic function through echo-derived haemodynamic forces was recently proposed, but its predictive value on sacubitril/valsartan response and cardiovascular events remained to be assessed.
Does baseline haemodynamic force-derived whole cardiac cycle left ventricular strength predict response to sacubitril/valsartan in patients with HFrEF?
Observational (n=89)
Yes
Does baseline haemodynamic force-derived whole cardiac cycle left ventricular strength predict response to sacubitril/valsartan in patients with HFrEF?
Haemodynamic force analysis, specifically whole cardiac cycle LV strength, is a promising non-invasive tool to predict which HFrEF patients will have favorable reverse remodeling and clinical response to ARNI therapy.
Baseline wLVS was associated with sacubitril/valsartan response in this HFrEF cohort; leaves open whether haemodynamic force analysis can guide ARNI selection.
AIMS: A novel tool for the evaluation of left ventricular (LV) systo-diastolic function through echo-derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6 month treatment response to sacubitril/valsartan in heart failure with reduced ejection fraction (HFrEF) patients and (ii) cardiovascular events. METHODS AND RESULTS: Eighty-nine consecutive HFrEF patients [70% males, 65 ± 9 years, LV ejection fraction (LVEF) 27 ± 7%] initiating sacubitril/valsartan underwent clinical, laboratory, ultrasound and cardiopulmonary exercise testing evaluations. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide and/or ≥10% LVEF increase over 6 months were considered responders. Patients were followed up for the composite endpoint of HF-related hospitalisation, atrial fibrillation and cardiovascular death. Forty-five (51%) patients were responders. Among baseline variables, only HDF-derived whole cardiac cycle LV strength (wLVS) was higher in responders (4.4 ± 1.3 vs. 3.6 ± 1.2; p = 0.01). wLVS was also the only independent predictor of sacubitril/valsartan response at multivariable logistic regression analysis [odds ratio 1.36; 95% confidence interval (CI) 1.10-1.67], with good accuracy at receiver operating characteristic (ROC) analysis [optimal cutpoint: ≥3.7%; area under the curve (AUC) = 0.736]. During a 33 month (23-41) median follow-up, a wLVS increase after 6 months (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off: ≥0.5%; AUC = 0.811), stratified prognosis (log-rank p < 0.0001) and remained an independent predictor for the composite endpoint (hazard ratio 0.76; 95% CI 0.61-0.95; p < 0.01), after adjusting for clinical and instrumental variables. CONCLUSIONS: HDF analysis predicts sacubitril/valsartan response and might optimise decision-making in HFrEF patients.
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Fabiani et al. (2023) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=89). Haemodynamic force-derived whole cardiac cycle left ventricular strength (wLVS) vs. Lower baseline wLVS was evaluated on Response to sacubitril/valsartan at 6 months (no adverse events and ≥50% reduction in NT-proBNP and/or ≥10% LVEF increase) (OR 1.36, 95% CI 1.10-1.67, p=0.004). Higher baseline whole cardiac cycle left ventricular strength (wLVS) independently predicted a favorable clinical and reverse remodeling response to sacubitril/valsartan at 6 months (OR 1.36).
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