The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure

Gao, Yang; Xing, Changtai; Hao, Wenjun; Zhao, Hongwei; Wang, Lili; Liu, Bo; Hou, Ai-jie

doi:10.1536/ihj.19-231

Cited by 16 publications

(14 citation statements)

References 21 publications

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“…Five RCTs reported renal function as primary or secondary outcome of interest, 11,14,18,20,28 while the remaining five RCTs only reported it as adverse event 24–27,29 …”

Section: Resultsmentioning

confidence: 99%

“…The study selection process is described in Figure . Among the initial 3483 records, 10 studies published between 2012 and 2019 met our inclusion criteria for a total of 16 456 subjects 11,14,18,20,24–29 . The mean age across the studies ranged from 57.6 to 72.7 years, and 10 949 (66.5%) participants were men.…”

Section: Resultsmentioning

confidence: 99%

“…The comparator was an ACEi in three studies 20,26,28 and an ARB in the remaining studies. 11,14,18,24,25,27,29 Most of the studies (n = 7) were conducted on HF patients, 11,18,20,[26][27][28][29] one of them in the acute setting. 28 One study was conducted on CKD patients 14 and two studies on patients with hypertension.…”

Section: Effect Of Sacubitril/valsartan On Renal Functionmentioning

confidence: 99%

“…Five RCTs reported renal function as primary or secondary outcome of interest, 11,14,18,20,28 while the remaining five RCTs only reported it as adverse event. [24][25][26][27]29 Overall, sacubitril/valsartan resulted in a lower risk of worsening renal function as compared with RAS inhibitors [pooled OR = 0.70 (95% CI 0.57-0.85), P < 0.001, Figure 2], with a moderate inconsistency between studies [Q(9) =15.18, P = 0.086, I 2 = 40.73%]. The funnel plot showed asymmetry with a similar estimated ES [estimated ES = 0.70 (95% CI 0.58-0.84), P < 0.001; number of trimmed studies: 2], although the Egger linear regression test was not significant (P = 0.699) ( Figure S1).…”

Section: Renal Outcomementioning

confidence: 99%

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Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

et al. 2020

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A worsening renal function is prevalent among patients with cardiovascular disease, especially heart failure (HF). Sacubitril/valsartan appears to prevent worsening of renal function and progression of chronic kidney disease (CKD) as compared with renin-angiotensin system (RAS) inhibitors alone in HF patients. It is unclear whether these advantages are present in HF patients only, or can be extended to other categories of patients, in which this drug was studied. We performed a systematic review and meta-analysis to assess the consistency of effect size regarding renal outcome across randomized controlled trials (RCTs) that compared sacubitril/valsartan with RAS inhibitors in patients with or without HF. We searched Medline (PubMed), Scopus, and Thomson Reuters Web of Science databases until June 2020. We took into account RCTs that compared sacubitril/valsartan with a RAS inhibitor and reported data regarding renal function. We used random-effects models to obtain summary odds ratio (OR) with 95% confidence interval (CI). We extracted hazard ratios for renal outcomes, glomerular filtration rate slopes or rates of renal adverse events. Sensitivity analyses were performed by moderator analysis and random-effects meta-regression. The search revealed 10 RCTs (published between 2012 and 2019) on 16 456 subjects. Sacubitril/valsartan resulted in a lower risk of renal dysfunction as compared with RAS inhibitors alone [k ¼ 10; pooled OR ¼ 0.70 (95% CI 0.57-0.85); P < 0.001], with a moderate inconsistency between studies [Q(9) ¼ 15.18; P ¼ 0.086; I 2 ¼ 40.73%]. A stronger association was found in studies including older patients (k ¼ 10; β ¼ À0.047730; P ¼ 0.020) or HF patients with preserved ejection fraction [pooled OR ¼ 0.53 (0.41-0.68) vs. 0.76 (0.57-1.01) for studies on HF patients with reduced ejection fraction; P for comparison ¼ 0.065]. The effect size did not change with different comparators (angiotensin-converting enzyme inhibitors vs. angiotensin II type 1 receptor blockers, P ¼ 0.279). No significant association was found when the analysis was restricted to studies on non-HF patients [k ¼ 3; pooled OR ¼ 0.86 (0.61-1.22); P ¼ 0.403] and studies with high risk of bias [k ¼ 3; pooled OR ¼ 0.34 (0.08-1.44); P ¼ 0.143]. Our findings support the role of sacubitril/valsartan on preservation of renal function, especially in older patients and HF patients with preserved ejection fraction. However, evidence is currently limited to HF patients, while the renal outcome of sacubitril/valsartan therapy outside the HF setting needs to be further investigated.

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“…Five RCTs reported renal function as primary or secondary outcome of interest, 11,14,18,20,28 while the remaining five RCTs only reported it as adverse event 24–27,29 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Effect Of Sacubitril/valsartan On Renal Functionmentioning

confidence: 99%

Section: Renal Outcomementioning

confidence: 99%

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Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

et al. 2020

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“…We can only speculate that the increase in mechanical stress associated with the prolonged systolic time may have induced a strain promoting membrane fragility in compromised cardiac myocytes. In contrast, using a hs-cTnT antibody, Packer et al and Gao et al [90,91] reported an improvement in function and a decrease in serum cTnT in chronic heart failure patients treated with angiotensin/neprilysiin inhibition. The initial trial testing Omecamtiv is in the process of being significantly expanded (GACTIC-HF) with an end point of improving clinical outcomes [92].…”

Section: Serum Ctni and Ctni Levels And Inotropic Interventionsmentioning

confidence: 96%

Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders

Solaro

2020

Journal of Molecular and Cellular Cardiology

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Cardiac troponin I (cTnI), the inhibitory-unit, and cardiac troponin T (cTnT), the tropomyosin-binding unit together with the Ca-binding unit (cTnC) of the hetero-trimeric troponin complex signal activation of the sarcomeres of the adult cardiac myocyte. The unique structure and heart myocyte restricted expression of cTnI and cTnT led to their worldwide use as biomarkers for acute myocardial infarction (AMI) beginning more than 30 years ago. Over these years, high sensitivity antibodies (hs-cTnI and hs-cTnT) have been developed. Together with careful determination of history, physical examination, and EKG, determination of serum levels using hs-cTnI and hs-cTnT permits risk stratification of patients presenting in the Emergency Department (ED) with chest pain. With the ability to determine serum levels of these troponins with high sensitivity came the question of whether such measurements may be of diagnostic and prognostic value in conditions beyond AMI. Moreover, the finding of elevated serum troponins in physiological states such as exercise and pathological states where cardiac myocytes may be affected requires understanding of how troponins may be released into the blood and whether such release may be benign. We consider these questions by relating membrane stability to the complex biology of troponin with emphasis on its sensitivity to the chemo-mechanical and micro-environment of the cardiac myocyte. We also consider the role determinations of serum troponins play in the precise phenotyping in personalized and precision medicine approaches to promote cardiac health.

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Sacubitril/valsartan

2020

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The Impact of Sacrubitril/Valsartan on Clinical Treatment and hs-cTnT and NT-ProBNP Serum Levels and the Left Ventricular Function in Patients with Chronic Heart Failure

Cited by 16 publications

References 21 publications

Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

Effect of sacubitril/valsartan on renal function: a systematic review and meta‐analysis of randomized controlled trials

Implications of the complex biology and micro-environment of cardiac sarcomeres in the use of high affinity troponin antibodies as serum biomarkers for cardiac disorders

Sacubitril/valsartan

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