Effect of sacubitril/valsartan on cardiac remodeling compared with other renin-angiotensin system inhibitors : a difference-in-difference analysis of propensity-score matched samples
© 2023. The Author(s)..
BACKGROUND: In patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin-angiotensin system (RAS) inhibitors is not well known.
METHODS: HFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8-12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups.
RESULTS: After propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator = + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient's age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both).
CONCLUSION: In HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Clinical research in cardiology : official journal of the German Cardiac Society - (2023) vom: 21. Sept. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Carluccio, Erberto [VerfasserIn] |
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| Links: |
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| Themen: |
ARNI |
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| Anmerkungen: |
Date Revised 21.09.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s00392-023-02306-0 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362297738 |
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| 100 | 1 | |a Carluccio, Erberto |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effect of sacubitril/valsartan on cardiac remodeling compared with other renin-angiotensin system inhibitors |b a difference-in-difference analysis of propensity-score matched samples |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 21.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: In patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin-angiotensin system (RAS) inhibitors is not well known | ||
| 520 | |a METHODS: HFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8-12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups | ||
| 520 | |a RESULTS: After propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator = + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient's age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both) | ||
| 520 | |a CONCLUSION: In HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ARNI | |
| 650 | 4 | |a Cardiac remodeling | |
| 650 | 4 | |a Heart failure, RAS inhibitors | |
| 650 | 4 | |a Neprilysin inhibitors | |
| 650 | 4 | |a Sacubitril/valsartan | |
| 700 | 1 | |a Dini, Frank L |e verfasserin |4 aut | |
| 700 | 1 | |a Correale, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Dattilo, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Ciccarelli, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Vannuccini, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Sforna, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Pacileo, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Masarone, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Scelsi, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Ghio, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Tocchetti, Carlo Gabriele |e verfasserin |4 aut | |
| 700 | 1 | |a Mercurio, Valentina |e verfasserin |4 aut | |
| 700 | 1 | |a Brunetti, Natale Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Nodari, Savina |e verfasserin |4 aut | |
| 700 | 1 | |a Ambrosio, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Palazzuoli, Alberto |e verfasserin |4 aut | |
| 700 | 0 | |a Working Group on Heart Failure of the Italian Society of Cardiology |e verfasserin |4 aut | |
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