Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fraction
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: We aimed to analyze the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) by the disease course of heart failure (HF). Methods: We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) ≤ 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admitted for HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months. Results: No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06–5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064). Conclusions: The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.
Abstract
Background/Aims: We aimed to analyze the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) by the disease course of heart failure (HF). Methods: We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) ≤ 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admitted for HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months. Results: No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06–5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064). Conclusions: The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.
참고문헌 (26)
- Kemp CD, "The pathophysiology of heart failure", Cardiovasc Pathol, 21, pp.365~371 (2012)
- Singh JS, "Angiotensin receptor-neprilysin inhibitors : clinical potential in heart failure and beyond", Vasc Health Risk Manag, 11, pp.283~295 (2015)
- McMurray JJ, "Angiotensin-neprilysin inhibition versus enalapril in heart failure", N Engl J Med, 371, pp.993~1004 (2014)
- Morrow DA, "Clinical outcomes in patients with acute decompensated heart failure randomly assigned to sacubitril", valsartan or enalapril in the PIONEER-HF trial, 2019, pp.139, 2285~2288
- McDonagh TA, "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure", Eur Heart J, 42, pp.3599~3726 (2021)
- Writing Committee Members, "2022 AHA", ACC, J Card Fail, pp.2022, 28[DOI]
- Wachter R, "Initiation of sacubitril", valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge:primary results of the randomised TRANSITION study, 2019, pp.21, 998~1007
- Senni M, "Initiation of sacubitril", valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study, 2020, pp.22, 303~312
- Myhre PL, "B-type natriuretic peptide during treatment with sacubitril", valsartan : the PARADIGM-HF trial, 2019, pp.73, 1264~1272
- Martens P, "The reverse remodeling response to sacubitril", valsartan therapy in heart failure with reduced ejection fraction, 2018, pp.36, e12435~
- Almufleh A, "Ejection fraction improvement and reverse remodeling achieved with Sacubitril", Valsartan in heart failure with reduced ejection fraction patients, 2017, pp.7, 108~113
- Castrichini M, "Sacubitril", valsartan induces global cardiac reverse remodeling in long-lasting heart failure with reduced ejection fraction : standard and advanced echocardiographic evidences, 2020, pp.9, 906~
- Maizels L, "Characterization of heart failure patients with reverse left ventricular remodelling post-angiotensin receptor blockers", neprilysin inhibitors therapy, 2022, pp.9, 1682~1688
- Iborra-Egea O, "Mechanisms of action of sacubitril", valsartan on cardiac remodeling : a systems biology approach, 2017, pp.3, 12~
- 안민수, "Prognostic Effect of Guideline-Directed Therapy Is More Noticeable Early in the Course of Heart Failure", Journal of Korean Medical Science, 34(17), pp.1~12 (2019), 대한의학회
- Pranata R, "Differences in clinical characteristics and outcome of de novo heart failure compared to acutely decompensated chronic heart failure-systematic review and meta-analysis", Acta Cardiol, 76, pp.410~420 (2021)
- Chioncel O, "Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction : an analysis of the ESC Heart Failure Long-Term Registry", Eur J Heart Fail, 19, pp.1574~1585 (2017)
- Park Jin Joo, "Real-World Usage of Sacubitril", Valsartan in Korea: A Multi-Center, Retrospective Study, 2022, pp.4(4), 193~[DOI]
- Kim H, "Clinical evidence of initiating a very low dose of sacubitril", valsartan : a prospective observational analysis, 2021, pp.11, 16335~
- Vardeny O, "Reduced loop diuretic use in patients taking sacubitril", valsartan compared with enalapril : the PARADIGM-HF trial, 2019, pp.21, 337~341
- Pharithi RB, "Sacubitril-Valsartan in a routine community population : attention to volume status critical to achieving target dose", ESC Heart Fail, 7, pp.158~166 (2020)
- Tsika EP, "The J-curve in arterial hypertension : fact or fallacy?", Cardiology, 129, pp.126~135 (2014)
- Lip S, "Diastolic blood pressure J-curve phenomenon in a tertiary-care hypertension clinic", Hypertension, 74, pp.767~775 (2019)
- Lee SE, "Reverse J-curve relationship between on-treatment blood pressure and mortality in patients with heart failure", JACC Heart Fail, 5, pp.810~819 (2017)
- Ho JE, "Predictors of new-onset heart failure : differences in preserved versus reduced ejection fraction", Circ Heart Fail, 6, pp.279~286 (2013)
- Lloyd-Jones DM, "Lifetime risk for developing congestive heart failure: the Framingham Heart Study", Circulation, 106, pp.3068~3072 (2002)