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NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction

2020; Elsevier BV; Volume: 8; Issue: 10 Linguagem: Inglês

10.1016/j.jchf.2020.05.012

2213-1787

Domingo A. Pascual‐Figal, Rolf Wachter, Michele Senni, Weibin Bao, Adele Noè, H. Schwende, Dmytro Butylin, Margaret F. Prescott, Jacek Gniot, М Е Можейко, Małgorzata Lelonek, A. Reyes Domínguez, Thomas Horacek, Enrique Garcia del Rio, Zhanna Kobalava, Christian Mueller, Yüksel Çavuşoğlu, Ewa Straburzyńska−Migaj, Miroslav Slanina, Juergen vom Dahl, Michele Senni, Alisdair Ryding, Andrew Moriarty, Manuel Beltrán Robles, Julio Núñez, Antonio García Quintana, Thorsten Nitschke, José Manuel García Pinilla, Luis Almenar Bonet, Said Chaaban, Samia Filali zaatari, Jindřich Špinar, Włodzimierz J. Musiał, Khaled Abdelbaki, Jan Bělohlávek, Wolfgang Fehske, Michael Carlos Bott, Geir Hoegalmen, Marisa Crespo Leiro, İsmail Türkay Özcan, Wilfried Müllens, Radim Kryza, Riadh Al‐Ani, Krystyna Łoboz‐Grudzień, Lyudmila Ermoshkina, Silvia Hojerova, Alberto Alfredo Fernandez, Lenka Špinarová, Harald Lapp, Efraim Bulut, Filipa Almeida, A. A. Vishnevsky, Margita Belicová, Domingo A. Pascual‐Figal, Klaus K. Witte, Kenneth Wong, Walter Droogné, Marc Delforge, Martin Peterka, Hans‐Georg Olbrich, Stefano Carugo, Jadwiga Nessler, Thao Huynh McGill, Burkhard Huegl, İbrahim Akın, Ilídio Moreira, А. Н. Багликов, Jeetendra Thambyrajah, Chris Hayes, Marcelo Barrionuevo, Zerrin Yiğit, Hakkı Kaya, Zdeněk Klimsa, Martin Radvan, C Kadel, Ulf Landmesser, Giuseppe Di Tano, Malgorzata Buksinska Lisik, Cândida Fonseca, Luís Oliveira, Irene Marques, Luís M.G. Santos, Egon Lenner, Peter Letavay, Manuel Gómez‐Bueno, Paula Mota, Aaron Wong, Kristian Bailey, Paul Foley, Eduardo Hasbani, Sean Virani, Tony Abdel Massih, Shukri AlSaif, Miloš Táborský, Marta Kaislerova, Zuzana Moťovská, Aron Ariel Cohen, Damien Logeart, Dierk Endemann, Daniel Ferreira, Dulce Brito, P Kycina, Entela Bollano, Enrique Galve Basilio, Lorenzo Fácila, Marcos Garcı́a Aguado, Lilia Beatriz Schiavi, Daniel Francisco Zivano, Eva Lonn, Ali El Sayed, Anne‐Catherine Pouleur, Alex Heyse, Alexandr Schee, Rostislav Polášek, Marek Houra, Christophe Tribouilloy, Marie France Séronde, Michel Galinier, Michel Noutsias, Peter Schwimmbeck, Ingo Voigt, Dirk Westermann, Giovanni Pulignano, Johnny Vegsundvaag, Alexandre Antunes, Pedro Monteiro, Ján Števlík, Eva Gonçalvesová, Beata Hulkoova, Antonio Fernández-Giménez, Ceri Davies, Iain Squire, Philippe Meyer, Richard Sheppard, Tayfun Şahı̇n, K Sochor, Guillaume De Geeter, Rolf Wachter, Alexander Schmeißer, Joachim Weil, Ana Oliveira Soares, Olga Bulashova Vasilevna, Andrey Oshurkov, Shahid Junejo Sunderland, Jason D. Glover, Tomas Exequiel, Eric Decoulx, Sven Meyer, Thomas Muenzel, Fernando Friões, G ARBOLISHVILI, A Tokarcíková, Patric Karlström, Joan Carles Trullàs Vila, Gonzalo Pena Perez, Rajiv Sankaranarayanan, Thuraia Nageh, Diego Alasia, Marwan M. Refaat, Burcu Demirkan, Jehad Al‐Buraiki, Shadi Karabsheh,

Mechanical Circulatory Support Devices

This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor–naive or angiotensin receptor blocker–naive, and no prior myocardial infarction. In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)