Association between measures of cardiac remodeling after ARNI and outcomes in HFrEF

Introduction and methods

Treatment with sacubitril/valsartan has resulted in improved outcomes in HFrEF patients. Although therapies that improve prognosis in HFrEF usually result in reverse cardiac remodeling [1], mechanisms of benefit by sacubitril/valsartan remain elusive. The PROVE-HF trial demonstrated that treatment with sacubitril/valsartan resulted in significant reduction of NT-proBNP and that both magnitude and speed of NT-proBNP reduction were associated with reverse modeling [2].

This analysis of PROVE-HF examined whether achievement of an above-average rate of change in NT-proBNP at 3 months and LV end-systolic volume index (LVESVi), which is a key index of remodeling, at 6 months was associated with outcomes between 6 and 12 months.

Participants without events at 6 months and with echocardiograms at baseline and 6 months were included (n=638). Outcomes of interest were HF hospitalization and death. Patients were grouped based on extent of change in each measure (above vs. at/below 95% CI lower bound for the linear slope).

Main results

• Event rates from month 6 to 12 were lower in patients with above-average reduction for NT-proBNP and LVESVi, intermediate for those with above-average reduction for at least 1 measure and events were highest in those with at/below-average reduction of NT-proBNP and LVESVi.
• After adjustment for demographics, outcomes were significantly higher for patients at/below-average linear slopes for both measures compared to patients above-average linear slopes for both measures (OD 2.03, 95%CI:1.25-3.30, P<0.001).

Conclusion

References

Find this article online at Circ Heart Fail.