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J Am Heart Assoc. 2024;13(21):e036763.

Characteristics, Predictors, and Clinical Outcomes in Heart Failure With Reduced Ejection Fraction According to a 1-Year Left Ventricular Ejection Fraction Following Sacubitril/Valsartan Treatment.

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제1저자 박찬순, 박지석 · 교신저자 김형관, 황인창

PMID 39450740 PMC11935735 DOI 10.1161/JAHA.124.036763 IF 6 순환기내과
소속 (3)
  1. Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea.
  2. Department of Internal Medicine Seoul National University College of Medicine Seoul Republic of Korea.
  3. Cardiovascular Center Seoul National University Bundang Hospital Seongnam-si Gyeonggi-do Republic of Korea.

Abstract

BACKGROUND Optimal medical treatment can lead to improvement in left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF). We investigated the characteristics, predictors, and outcomes of HFrEF according to the 1-year LVEF following angiotensin receptor-neprilysin inhibitors therapy (ARNI).

METHODS AND RESULTS Using the STRATS-HF-ARNI (Strain for Risk Assessment and Therapeutic Strategies in Patients With Heart Failure Treated With Angiotensin Receptor-Neprilysin Inhibitor) registry, we identified 1074 patients with HFrEF who took ARNI and underwent baseline and 1-year echocardiography. Patients were classified as HF with improved ejection fraction (HFimpEF) and persistent HFrEF (perHFrEF) (1-year LVEF >40% and ≤40%). The primary and secondary outcomes were all-cause and cardiac mortality from the 1-year follow-up. Among 1074 included patients, 498 (46.4%) had HFimpEF, and 576 (53.6%) had perHFrEF. Older age, male sex, and large LV end-diastolic volumes were positive predictors of perHFrEF, whereas atrial fibrillation and high systolic blood pressure were identified as inverse predictors. Patients with HFimpEF showed lower all-cause and cardiac mortality rates (both log-rank P<0.001). In the multivariable analysis, perHFrEF (hazard ratio, 2.402 [95% CI, 1.251-4.610]; P=0.008) was an independent predictor of poor outcomes. The risk of all-cause mortality decreased as the 1-year LVEF increased up to 40%; however, no additional risk reduction was observed beyond 40%. Compared with patients taking renin-angiotensin-aldosterone system inhibitors in the STRATS-AHF (Strain for Risk Assessment and Therapeutic Strategies in Patients With Acute Heart Failure) registry, those in the STRATS-HF-ARNI registry demonstrated better outcomes in both HFimpEF and perHFrEF.

CONCLUSIONS Patients with HFimpEF had better prognosis than those with perHFrEF, and ARNI treatment in HFrEF could be more beneficial than renin-angiotensin-aldosterone system inhibitors for both HFimpEF and perHFrEF.

REGISTRATION URL: https://www.who.int/clinical-trials-registry-platform; Unique identifier: KCT0008098.

Keywords

ARNIejection fractionheart failuremortality

Figures

Figure 1
Figure 1 Schematic diagram of the study process. Illustrations of the study population (A) and study flow chart (B) are presented. ARNI indicates angiotensin receptor–neprilysin inhibitor; HFimpEF, heart failure with improved ejection fraction; HFrEF, heart failure with reduced ejection fraction; and LVEF, left ventricular ejection fraction.
Figure 2
Figure 2 Comparison of clinical outcomes between the groups with HFimpEF and persistent HFrEF. Kaplan–Meier survival curves of all‐cause mortality (A) and cardiac mortality (B) according to the heart failure phenotype are presented. HFimpEF indicates heart failure with improved ejection fraction; and HFrEF, heart failure with reduced ejection fraction.
Figure 3
Figure 3 All‐cause mortality in association with the subclassification of a 1‐year LVEF. In the groups with HFimpEF (A) and persistent HFrEF (B), the patients were subcategorized into 2 groups based on their 1‐year LVEF: HFimpEF into HFpEF at 1 year (LVEF ≥50%) and HFmrEF at 1 year (LVEF 40%–49%), and persistent HFrEF into HF with severely reduced EF (LVEF ≤30%) and HF with moderately reduced EF (LVEF 31%–40%). The restricted cubic spline curves illustrate the association between the 1‐year LVEF and outcomes (C). HFimpEF indicates heart failure with improved ejection fraction; HFmrEF, heart failure with midrange ejection fraction; HFpEF, heart failure with preserved ejection fraction; and LVEF, left ventricular ejection fraction.
Figure 4
Figure 4 Comparison of clinical outcomes between patients taking RASis from the STRATS‐AHF registry and those from the STRATS‐HF‐ARNI registry. A, The proportions of patients with HFimpEF and persistent HFrEF from each registry. Kaplan–Meier curves represent the clinical outcomes of patients in the STRATS‐HF‐ARNI registry and those in the STRATS‐AHF registry who had HFimpEF (B) and persistent HFrEF (C) treated with RASis. HFimpEF indicates heart failure with improved ejection fraction; HFrEF, heart failure with reduced ejection fraction; RASi, renin‐angiotensin‐aldosterone system inhibitor; STRATS‐AHF, Strain for Risk Assessment and Therapeutic Strategies in Patients With Acute Heart Failure; and STRATS‐HF‐ARNI, Strain for Risk Assessment and Therapeutic Strategies in Patients With Heart Failure Treated With Angiotensin Receptor‐Neprilysin Inhibitors.

그림 출처: PubMed Central 공개 논문 (PMC11935735)

그 밖의 정보
출판 형태
Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't
저널
Journal of the American Heart Association · eISSN 2047-9980
전자 출판
2024-10-25
MeSH
Humans · Male · Heart Failure* / drug therapy / physiopathology / mortality · Valsartan* / therapeutic use · Biphenyl Compounds* / therapeutic use · Female · Aminobutyrates* / therapeutic use · Stroke Volume* / drug effects / physiology · Aged · Drug Combinations* · Middle Aged · Angiotensin Receptor Antagonists* / therapeutic use · Ventricular Function, Left* / drug effects · Registries* · Neprilysin* / antagonists & inhibitors · Treatment Outcome · Time Factors · Tetrazoles / therapeutic use · Recovery of Function · Risk Factors · Echocardiography
Substances
Valsartan · Biphenyl Compounds · Aminobutyrates · sacubitril and valsartan sodium hydrate drug combination · Drug Combinations · Angiotensin Receptor Antagonists · Neprilysin · Tetrazoles
참고문헌
34편