Association between sacubitril/valsartan initiation and changes in left ventricular ejection fraction: Insights from ARIADNE registry.

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. 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. 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]). 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.

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest LHL reports research grants from AstraZeneca, Novartis, Boehringer Ingelheim, Vifor-Fresenius, and Boston Scientific; consulting or speaker's honoraria from AstraZeneca, Novartis, Boehringer Ingelheim, Vifor-Fresenius, Bayer, Pharmacosmos, Abbott, Sanofi, Merck, Myokardia, Orion Pharma, MedScape, Radcliffe Cardiology, Lexicon, and Respicardia; and stock ownership in AnaCardio; outside the submitted work. UZ has received research funding as well as speaker and consulting honoraria from Novartis. ALC has received funding for travel to meetings from Novartis as well as unrestricted grants for the support of his department. VB has received funding for travel to meetings from Novartis as well as fees for lectures and unrestricted grants for clinical research. JD has received honoraria for participation in committees of studies sponsored by Novartis. CF has received speaker fees and honoraria for consulting from Novartis, Servier, Bayer, OMPharma, and Daiichi Sankyo. SK is an employee of GKM (clinical research organization) contracted for data analysis by Novartis. PCF and CK are employees of Novartis. APM has received personal fees for participation in study committees of trials funded by Novartis, Bayer, Cardiorentis, and Fresenius.