Baseline characteristics of patients in the PARALLAX trial: insights into quality of life and exercise capacity in heart failure with preserved ejection fraction. (26th July 2021)

• Record Type: Journal Article
• Authors: Shah, Sanjiv J.; Cowie, Martin R.; Wachter, Rolf; Szecsödy, Peter; Shi, Victor; Ibram, Ghionul; Hu, Mo; Zhao, Ziqiang; Gong, Jianjian; Pieske, Burkert
• Is Part Of: European journal of heart failure. Volume 23:Number 9(2021)
• Page Start: 1541
• Page End: 1551
• Publication Date: 2021-07-26
• Subjects: Heart failure with preserved ejection fraction -- Randomized controlled trial -- Quality of life -- Exercise capacity -- Angiotensin receptor–neprilysin inhibitor; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2277
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: We sought to describe the baseline characteristics of PARALLAX [a randomized controlled trial of sacubitril/valsartan vs. individualized medical therapy in heart failure (HF) with mildly reduced and preserved ejection fraction (HFpEF)]; compare PARALLAX to recent HFpEF trials; and examine the clinical characteristics associated with quality of life (QOL) and 6‐min walk test distance (6MWD). Methods and results: A total of 2566 patients with HF and left ventricular ejection fraction (LVEF) >40% were randomized, of whom 96% had an LVEF ≥45%. Multivariable linear regression was used to determine characteristics associated with Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ‐CSS) and 6MWD. Mean age was 73 ± 8 years, 51% were female, and comorbidities were common. Of the QOL measures tested in PARALLAX, the Short Form Health Survey‐36 physical functioning score was most closely correlated with 6MWD (R = 0.41, P < 0.001), and outperformed the KCCQ physical limitation score (R = 0.33) and KCCQ‐CSS (R = 0.31) on multivariable analyses. Female sex, higher body mass index, history of coronary artery disease, lower LVEF, and higher N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) were associated with worse (lower) KCCQ‐CSS; older age, female sex, higher body mass index, diabetes, coronary artery disease, chronic obstructive pulmonary disease, prior HF hospitalization, lower LVEF, and higher NT‐proBNP were associated with shorter 6MWD ( P < 0.05 for all associations). Conclusions: PARALLAX is the largest HFpEF study to date to examine 6MWD together with QOL. The KCCQ‐CSS and 6MWD were modestly correlated, and several factors were associated with worse values of both. These results provide insight into the association between QOL and exercise capacity in HFpEF. Abstract : Summary of the PARALLAX trial and the relationship between N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), 6‐min walk test distance (6MWD), Kansas City Cardiomyopathy Questionnaire (KCCQ), Short Form Health Survey‐36 (SF‐36), and heart failure signs and symptoms. ACE‐I, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; HF, heart failure; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; RASi, renin–angiotensin system inhibitor; RCT, randomized controlled trial.