Sacubitril/valsartan yielded similar improvements in biomarkers, health status, and cardiac remodeling (median LVEF improvement 8.7% to 10.2%) across low, moderate, and high dose tertiles.
Does the dose of sacubitril/valsartan affect improvements in prognostic biomarkers, health status, and cardiac remodeling in patients with HFrEF?
In patients with HFrEF, lower achieved doses of sacubitril/valsartan are associated with similar improvements in biomarkers, health status, and cardiac reverse remodeling compared to higher doses.
BACKGROUND: Doses of sacubitril/valsartan (Sac/Val) achieved in clinical trials of heart failure with reduced ejection fraction (HFrEF) are often not reached in clinical practice. OBJECTIVES: The purpose of this study was to investigate associations among Sac/Val doses and changes in prognostic biomarkers, health status, and cardiac remodeling among individuals with HFrEF through 12 months of treatment with Sac/Val administered per usual care. METHODS: A total of 794 persons with HFrEF (ejection fraction EF ≤40%) were categorized according to average daily doses of Sac/Val divided into tertiles. Change from baseline to 12 months in biomarkers (N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, soluble ST2, atrial natriuretic peptide, urinary cyclic guanosine monophosphate), Kansas City Cardiomyopathy Questionnaire-23 scores, and parameters of cardiac reverse remodeling (left ventricular EF, indexed left atrial and ventricular volumes, and E/e') were assessed. RESULTS: The average daily dose was 112 mg in Tertile 1 (low dose), 342 mg in Tertile 2 (moderate dose), and 379 mg in Tertile 3 (high dose). Similar changes in prognostic biomarkers were observed in all dose tertiles. Gains in Kansas City Cardiomyopathy Questionnaire-23 scores were comparable regardless of dose category. Consistent reverse cardiac remodeling in all dose categories occurred; the median absolute left ventricular EF improvement across HF dose groups was 9.3%, 8.7%, and 10.2%, for low, moderate, and high doses, respectively; similar improvements in left atrial and ventricular volumes and E/e' were also observed across dose categories. CONCLUSIONS: Among patients with HFrEF, similar improvement in prognostic biomarkers, health status, and cardiac remodeling were observed across various Sac/Val doses. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes PROVE-HF; NCT02887183.
Mohebi et al. (Sat,) conducted a other in Heart failure with reduced ejection fraction (HFrEF) (n=794). Sacubitril/valsartan vs. Different dose tertiles was evaluated on Change from baseline to 12 months in biomarkers, Kansas City Cardiomyopathy Questionnaire-23 scores, and parameters of cardiac reverse remodeling. Sacubitril/valsartan yielded similar improvements in biomarkers, health status, and cardiac remodeling (median LVEF improvement 8.7% to 10.2%) across low, moderate, and high dose tertiles.