Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril‐Valsartan: A Multicenter Echocardiographic Registry

Mandoli, Giulia Elena; Pastore, María; Giannoni, Alberto; Benfari, Giovanni; Dini, Frank Lloyd; Rosa, Gianmarco; Pugliese, Nicola Riccardo; Taddei, C; Correale, Michele; Brunetti, Natale Daniele; Mazzeo, Pietro; Carluccio, Erberto; Mengoni, Anna; Guaricci, Andrea Igoren; Piscitelli, Laura; Citro, Rodolfo; Ciccarelli, Michele; Novo, Giuseppina; Corrado, Egle; Pasquini, Annalisa; Loria, Valentina; Carli, Giuseppe De; Degiovanni, Anna; Patti, Giuseppe; Santoro, Ciro; Moderato, Luca; Cicoira, Mariantonietta; Canepa, Marco; Malagoli, Alessandro; Emdin, Michele; Cameli, Matteo

doi:10.1002/ehf2.14155

Cited by 9 publications

(4 citation statements)

References 46 publications

(86 reference statements)

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“…These considerations might support a possible role of ARNI for the management of patients with HF with mildly reduced EF (HFmrEF). The amount of LV remodeling and functional improvement seen in our study after S/V initiation is consistent with that of other prospective observational studies [ 27 , 28 ] and highlights the need for serial echocardiographic reassessment in HFrEF after diseased-modifying HF therapies that could help saving the indication for implantable cardioverter-defibrillator for arrhythmic primary prevention [ 28 ], according to the current criteria.…”

Section: Discussionsupporting

confidence: 89%

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin–angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

Carluccio,

Dini,

Correale

et al. 2023

Clin Res Cardiol

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Background In patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril–valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin–angiotensin system (RAS) inhibitors is not well known. Methods HFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8–12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups. Results After propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator = + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient’s age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both). Conclusion In HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors. Graphical abstract

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Section: Discussionsupporting

confidence: 89%

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin–angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

Carluccio,

Dini,

Correale

et al. 2023

Clin Res Cardiol

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“…Moreover, Jung et al demonstrated that LV GLPS values measured by STE at baseline were higher in DCM patients with LVRR (11.9 ± 1.6 vs. 8.2 ± 2.9, P < 0.001) 12 . The LV GLPS values of DCM patients have improved after a median follow‐up of 6–9 months after OMT 40,41 . Our study, further found that rGLPS (cutoff value of 0.045), rather than GLPS, was an independent determinant of LVRR in DCM patients 13,41 .…”

Section: Discussionsupporting

confidence: 63%

“…The LV GLPS values of DCM patients have improved after a median follow‐up of 6–9 months after OMT 40,41 . Our study, further found that rGLPS (cutoff value of 0.045), rather than GLPS, was an independent determinant of LVRR in DCM patients 13,41 . Myocardial strain depends not only on myocardial contraction but also on intracellular, extracellular, and molecular components of the myocardium 42 .…”

Section: Discussionsupporting

confidence: 57%

“… 40 , 41 Our study, further found that rGLPS (cutoff value of 0.045), rather than GLPS, was an independent determinant of LVRR in DCM patients. 13 , 41 Myocardial strain depends not only on myocardial contraction but also on intracellular, extracellular, and molecular components of the myocardium. 42 This can be reflected by the mass of the myocardium.…”

Section: Discussionsupporting

confidence: 56%

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The potential predictive value of cardiac mechanics for left ventricular reverse remodelling in dilated cardiomyopathy

Kan,

Fang,

et al. 2023

ESC Heart Failure

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AimsLeft ventricular reverse remodelling (LVRR) is an important objective of optimal medical management for dilated cardiomyopathy (DCM) patients, as it is associated with favourable long‐term outcomes. Cardiac magnetic resonance (CMR) can comprehensively assess cardiac structure and function. We aimed to assess the CMR parameters at baseline and investigate independent variables to predict LVRR in DCM patients.Methods and resultsNighty‐eight initially diagnosed DCM patients who underwent CMR and echocardiography examinations at baseline were included. CMR parameters and feature tracking (FT) based left ventricular (LV) global strain (nStrain) and nStrain indexed to LV cardiac mass index (rStrain) were measured. The predictors of LVRR were determined by multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of CMR parameters and were compared by the DeLong test. At a median follow‐up time of 9 [interquartile range, 7–12] months, 35 DCM patients (36%) achieved LVRR. The patients with LVRR had lower LV volume, mass, LGE extent and stroke volume index (LVSVi) and higher left ventricular remodelling index (LVRI), nStrains, rStrains, and peak systolic strain rate (PSSR) in the longitudinal direction and rStrains in the circumferential direction at baseline (all P < 0.05). In the multivariate logistic regression analyses, LVRI [per SD, odds ratio (OR) 1.79; 95% confidence interval (CI) 1.08–2.98; P = 0.024] and the ratio of global longitudinal peak strain (rGLPS) (per SD, OR 1.88; 95% CI 1.18–3.01; P = 0.008) were independent predictors of LVRR. The combination of LVSVi, LVRI, and rGLPS had a greater area under the curve (AUC) than the combination of LVSVi and LVRI (0.75 vs. 0.68), but not significantly (P = 0.09).ConclusionsPatients with LVRR had a lower LV volume index, lower LVSV index, lower LGE extent, higher LVRI, and preserved myocardial deformation in the longitudinal direction at baseline. LVRI and rGLPS at baseline were independent determinants of LVRR.

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Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril‐Valsartan: A Multicenter Echocardiographic Registry

et al. 2022

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Aims Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. Methods and resultsPatients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10% at follow-up] at 6 month follow-up as the primary endpoint. Changes in symptoms [New York Heart Association (NYHA) class] and neurohormonal activations [N-terminal pro-brain natriuretic peptide (NT-proBNP)] were also evaluated as secondary endpoints; 341 patients (excluding patients with poor acoustic windows and missing data) were analysed (mean age: 65 ± 10 years; 18% female, median LVEF 30% [inter-quartile range: 25À34]). At 6 month follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥ 35%), 55 (16%) early incomplete response (LVRR and LVEF < 35%), and 204 (60%) no response (no LVRR and LVEF < 35%). Non-ischaemic aetiology, a lower left atrial volume index, and a higher GLS were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). A baseline GLS < À9.3% was significantly associated with early response (area under the curve 0.75, P < 0.0001). Left atrial strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05). Conclusions Speckle tracking echocardiography parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan and could be used as a guide for treatment in patients with HFrEF.

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Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril‐Valsartan: A Multicenter Echocardiographic Registry

Cited by 9 publications

References 46 publications

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin–angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

Effect of sacubitril/valsartan on cardiac remodeling compared with other renin–angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples

The potential predictive value of cardiac mechanics for left ventricular reverse remodelling in dilated cardiomyopathy

Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril‐Valsartan: A Multicenter Echocardiographic Registry

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