Association between sacubitril/valsartan initiation and changes in left ventricular ejection fraction: Insights from ARIADNE registry. (1st January 2023)

• Record Type: Journal Article
• Authors: Lund, Lars H.; Zeymer, Uwe; Clark, Andrew L.; Barrios, Vivencio; Damy, Thibaud; Drożdż, Jaroslaw; Fonseca, Candida; Kalus, Stefanie; Ferber, Philippe C.; Koch, Cornelia; Maggioni, Aldo P.
• Is Part Of: International journal of cardiology. Volume 370(2023)
• Page Start: 279
• Page End: 286
• Publication Date: 2023-01-01
• Subjects: Heart failure -- Left ventricular ejection fraction -- Real-world -- Reverse cardiac remodeling -- Sacubitril/valsartan -- Trial registration: EUPAS 13835.; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.10.012
• Languages: English
• ISSNs: 0167-5273

Abstract

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. 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