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Association between sacubitril/valsartan initiation and changes in left ventricular ejection fraction: Insights from ARIADNE registry

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Lars H. Lund
    Correspondence
    Corresponding author at: Department of Medicine, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, S1:02, 1717 76 Stockholm, Sweden.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Affiliations
    Department of Medicine, Karolinska Institutet, And Heart Vascular and Neuro Theme Karolinska University Hospital, Stockholm, Sweden
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Uwe Zeymer
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Affiliations
    Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen-am-Rhein, Germany
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Andrew L. Clark
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Affiliations
    Castle Hill Hospital, Kingston Upon Hull, United Kingdom
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Vivencio Barrios
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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    University Hospital Ramon y Cajal de Madrid, Madrid, Spain
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    Thibaud Damy
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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    University Hospital Henri Mondor, Créteil, France
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    Jaroslaw Drożdż
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    Medical University of Lodz, Lodz, Poland
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    Candida Fonseca
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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    Hospital de Sao Francisco Xavier, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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    Stefanie Kalus
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    GKM Gesellschaft für Therapieforschung mbH, Munich, Germany
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    Philippe C. Ferber
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
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    Novartis Pharma AG, Basel, Switzerland
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Cornelia Koch
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    Novartis Pharma AG, Basel, Switzerland
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Aldo P. Maggioni
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
    Affiliations
    Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy

    Maria Cecilia Hospital, GVM Care & Research, Italy
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  • on behalf of the ARIADNE investigators
  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation
Published:October 07, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.10.012

      Highlights

      • In this European prospective observational analysis of 2602 patients with HFrEF, there was a greater mean increase in LVEF in patients initiated on sacubitril/valsartan as compared to usual care over 12 months follow-up
      • The association between initiation of sacubitril/valsartan and subsequent increase in LVEF was independent of baseline variables and other therapy
      • The findings from this analysis indicate that initiation of sacubitril/valsartan may lead to favorable LV remodeling, and this may be one reason sacubitril/valsartan improves outcomes

      Abstract

      Aims

      We tested the hypothesis that initiation versus non-initiation of sacubitril/valsartan is associated with a more favorable subsequent change in left ventricular ejection fraction (LVEF) in a real-world setting.

      Methods

      A prospective, non-randomized, double-arm, open-label, cohort study had been conducted across 687 centers in 17 European countries enrolling HFrEF patients aged ≥18 years with symptoms of HF (New York Heart Association [NYHA] II–IV) and “reduced LVEF”. For the current analysis, 2602 patients with LVEF measured at baseline and follow-up were chosen, of which 860 (33%, mean age 67 years, 26% women) were started on sacubitril/valsartan at baseline and 1742 (67%, 68 years, 23% women) were not. Patients started on sacubitril/valsartan had higher NYHA class and lower LVEF.

      Results

      LVEF increased from mean 32.7% to 38.1% in the sacubitril/valsartan group versus from 35.9% to 38.7% in the non-sacubitril/valsartan group (mean difference in increase 2.6%, p < 0.001). LVEF increased from baseline in 64% versus 53% of patients and increased by ≥5% (absolute %) in 50% versus 35% of patients in the sacubitril/valsartan versus non-sacubitril/valsartan groups, respectively. In the overall cohort, initiation of sacubitril/valsartan was independently associated with any increase in LVEF (adjusted odds ratio [OR] 1.49 [1.26–1.75]) and with increase by ≥5% (OR 1.65 [1.39–1.95]).

      Conclusion

      Initiating versus not initiating sacubitril/valsartan was independently associated with a greater subsequent increase in LVEF in this real-world setting. Reverse cardiac remodeling may be one mechanism of benefit of sacubitril/valsartan.

      Keywords

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