Troponin‐I levels as a potential prognostic biomarker of sacubitril/valsartan treatment response in heart failure with reduced ejection fraction: Who will benefit most?

Nakou, Eleni; Marketou, Maria; Chlouverakis, Gregory; Patrianakos, Alexandros; Vardas, Panos; Parthenakis, Fragiskos I.

doi:10.1002/clc.23099

Cited by 7 publications

(12 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean follow‐up duration ranged from 3 to 17.1 months. Of the 10 included studies, 6 13 , 15 , 22 , 23 , 24 , 25 were prospective, and 4 14 , 26 , 27 , 28 were retrospective. One study 24 had a control group that received angiotensin‐converting enzyme inhibitor, whereas the others had no control group.…”

Section: Resultsmentioning

confidence: 99%

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Zhang

Qin

et al. 2022

JAHA

View full text Add to dashboard Cite

Background Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension. Methods and Results We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle‐Ottawa scale. Variables were pooled using a random‐effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33–2.18 mm; P =0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25–1.45 cm/s; P =0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38–9.03 mm Hg; P <0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data ( P =0.026). Conclusions This meta‐analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle. Registration URL: https://www.crd.york.ac.uk/prospero ; Unique identifier: CRD42021247970.

show abstract

Section: Resultsmentioning

confidence: 99%

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Zhang

Qin

et al. 2022

JAHA

View full text Add to dashboard Cite

show abstract

“…Only a few studies have indicated possible predictors for a favorable response to SV in ambulatory patients with HF ( Martens et al, 2018 ; Nakou et al, 2018 ; Vicent et al, 2019 ; Chang et al, 2020 ; Díez-Villanueva et al, 2020 ) ( Table 4 ). These are observational cohort studies, most reflecting single-center experiences, and with a follow-up of less than 1 year after the start of the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies agreed that higher doses of SV were more likely to observe a favorable response ( Martens et al, 2018 ; Chang et al, 2020 ). Other predictors proposed were female sex ( Vicent et al, 2019 ), the absence of an ICD ( Díez-Villanueva et al, 2020 ), the non-ischemic etiology of HF ( Chang et al, 2020 ), the smaller diameter of the LV ( Chang et al, 2020 ), and the plasmatic levels of troponin ( Nakou et al, 2018 ). In this regard, our study coincides in that women were significantly more frequent “super-responders” than men.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a sub-analysis of this study showed that patients with a higher decrease in NT-proBNP levels or in left ventricular end diastolic diameter during the first 6 months after SV initiation had a lower rate of HF hospitalizations or death in the following months ( Januzzi et al, 2020 ). However, the identification of such predictors of super-response to ARNI is insufficient so far ( Martens et al, 2018 ; Nakou et al, 2018 ; Moliner-Abós et al, 2019 ; Vicent et al, 2019 ; Chang et al, 2020 ; Díez-Villanueva et al, 2020 ). In addition, since its approval in late 2015 the implementation of SV in daily clinical practice has been poor, partially due to high cost ( Di Tano and Bettari, 2017 ; DeVore et al, 2018 ; Sangaralingham et al, 2018 ; Kahn et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Simple Score to Identify Super-Responders to Sacubitril/Valsartan in Ambulatory Patients With Heart Failure

et al. 2021

View full text Add to dashboard Cite

IntroductionSacubitril/valsartan (SV) promotes cardiac remodeling and improves prognosis in patients with heart failure (HF). However, the response to the drug may vary between patients and its implementation in daily clinical practice has been slower than expected. Our objective was to develop a score predicting the super-response to SV in HF outpatients.MethodsThis is a retrospective analysis of 185 consecutive patients prescribed SV from two tertiary hospitals between September 2016 and February 2018. Super-responder was defined as a patient taking the drug and (i) without HF admissions, death, or heart transplant, and (ii) with a ≥50% reduction in NT-proBNP levels and/or an increase of ≥10 points in LVEF in a 12-month follow-up period after starting SV. Clinical, echocardiographic, ECG, and biochemical variables were used in a logistic regression analysis to construct a score for super-response to SV which was internally validated using bootstrap method.ResultsOut of 185 patients, 65 (35%) fulfilled the super-responder criteria. Predictors for super-response to SV were absence of both previous aldosterone antagonist and diuretic treatment, NYHA I-II class, female gender, previous 1-year HF admission, and sinus rhythm. An integrating score distinguished a low- (<25%), intermediate- (∼46%), and high-probability (>80%) for 1-year super-response to SV. The AUC for the model was 0.72 (95%CI: 0.64–0.80), remaining consistent after internal validation.ConclusionOne-third of our patients presented a super-response to SV. We propose an easy-to-calculate score to predict super-response to SV after 1-year initiation based on variables that are currently assessed in clinical practice.

show abstract

“…Elevation of troponin is a very frequent finding in patients hospitalized for acute decompensated HF and is associated with poor outcomes during hospitalization and increased risk of death or rehospitalizations after discharge [19]. Nakou et al [20] already showed that troponin I concentrations may be an independent predictive marker of a sacubitril/ /valsartan positive response in HFrEF.…”

Section: Timementioning

confidence: 99%

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Tymińska¹,

Ozierański²,

Grabowski³

et al. 2020

Cardiol J.

View full text Add to dashboard Cite

Despite significant diagnostic and therapeutic advances, heart failure (HF) is linked with high mortality and morbidity. Hospitalization for decompensated HF is still the most common cause of hospitalization in adults. What is more, a particularly high risk of hospitalization (even up to 50% of patients) is observed within a few months after a previous HF hospitalization. Sacubitril/valsartan, a first-in-class drug, contains a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). In PARADIGM-HF trial investigators showed, that sacubitril/valsartan significantly reduced primary endpoint combined with cardiovascular death or HF hospitalization in patients with chronic, symptomatic HF (New York Heart Association class II-IV) with reduced ejection fraction (left ventricular ejection fraction . Recently, results of the PIONEER-HF trial, which included HF patients with LVEF ≤ 40% who were hospitalized for acute decompensated HF were also published. The study proved that early, in-hospital, implementation of sacubitril/valsartan in these patients resulted in a substantially greater reduction of N-terminal prohormone B-type natriuretic peptide concentration and a lower rate of HF rehospitalizations with similar safety profile for enalapril.

show abstract

Troponin‐I levels as a potential prognostic biomarker of sacubitril/valsartan treatment response in heart failure with reduced ejection fraction: Who will benefit most?

Cited by 7 publications

References 22 publications

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies

A Simple Score to Identify Super-Responders to Sacubitril/Valsartan in Ambulatory Patients With Heart Failure

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Contact Info

Product

Resources

About