Objectives: This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. Background: NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Methods: Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. Results: In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor–naive or angiotensin receptor blocker–naive, and no prior myocardial infarction. Conclusions: In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)

Pascual-Figal, D., Wachter, R., Senni, M., Bao, W., Noe, A., Schwende, H., et al. (2020). NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study. JACC. HEART FAILURE, 8(10), 822-833 [10.1016/j.jchf.2020.05.012].

NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study

Senni M.;
2020

Abstract

Objectives: This study examined the effects of sacubitril/valsartan on N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. Background: NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). Methods: Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. Results: In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor–naive or angiotensin receptor blocker–naive, and no prior myocardial infarction. Conclusions: In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217)
Articolo in rivista - Articolo scientifico
acute decompensated heart failure; heart failure with reduced ejection fraction; N-terminal pro–B-type natriuretic peptide; sacubitril/valsartan; TRANSITION study;
English
822
833
12
Pascual-Figal, D., Wachter, R., Senni, M., Bao, W., Noe, A., Schwende, H., et al. (2020). NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study. JACC. HEART FAILURE, 8(10), 822-833 [10.1016/j.jchf.2020.05.012].
Pascual-Figal, D; Wachter, R; Senni, M; Bao, W; Noe, A; Schwende, H; Butylin, D; Prescott, M; Gniot, J; Mozheiko, M; Lelonek, M; Dominguez, A; Horacek, T; Garcia del Rio, E; Kobalava, Z; Mueller, C; Cavusoglu, Y; Straburzynska-Migaj, E; Slanina, M; vom Dahl, J; Ryding, A; Moriarty, A; Robles, M; Villota, J; Quintana, A; Nitschke, T; Garcia Pinilla, J; Bonet, L; Chaaban, S; Filali zaatari, S; Spinar, J; Musial, W; Abdelbaki, K; Belohlavek, J; Fehske, W; Bott, M; Hoegalmen, G; Leiro, M; Ozcan, I; Mullens, W; Kryza, R; Al-Ani, R; Loboz-Grudzien, K; Ermoshkina, L; Hojerova, S; Fernandez, A; Spinarova, L; Lapp, H; Bulut, E; Almeida, F; Vishnevsky, A; Belicova, M; Witte, K; Wong, K; Droogne, W; Delforge, M; Peterka, M; Olbrich, H; Carugo, S; Nessler, J; Mcgill, T; Huegl, B; Akin, I; Moreira, I; Baglikov, A; Thambyrajah, J; Hayes, C; Barrionuevo, M; Yigit, Z; Kaya, H; Klimsa, Z; Radvan, M; Kadel, C; Landmesser, U; Di Tano, G; Lisik, M; Fonseca, C; Oliveira, L; Marques, I; Santos, L; Lenner, E; Letavay, P; Bueno, M; Mota, P; Wong, A; Bailey, K; Foley, P; Hasbani, E; Virani, S; Massih, T; Al-Saif, S; Taborsky, M; Kaislerova, M; Motovska, Z; Cohen, A; Logeart, D; Endemann, D; Ferreira, D; Brito, D; Kycina, P; Bollano, E; Basilio, E; Rubio, L; Aguado, M; Schiavi, L; Zivano, D; Lonn, E; El Sayed, A; Pouleur, A; Heyse, A; Schee, A; Polasek, R; Houra, M; Tribouilloy, C; Seronde, M; Galinier, M; Noutsias, M; Schwimmbeck, P; Voigt, I; Westermann, D; Pulignano, G; Vegsundvaag, J; Da Silva Antunes, J; Monteiro, P; Stevlik, J; Goncalvesova, E; Hulkoova, B; Castro Fernandez, A; Davies, C; Squire, I; Meyer, P; Sheppard, R; Sahin, T; Sochor, K; De Geeter, G; Schmeisser, A; Weil, J; Soares, A; Bulashova, O; Oshurkov, A; Sunderland, S; Glover, J; Exequiel, T; Decoulx, E; Meyer, S; Muenzel, T; Frioes, F; Arbolishvili, G; Tokarcikova, A; Karlstrom, P; Trullas Vila, J; Perez, G; Sankaranarayanan, R; Nageh, T; Alasia, D; Refaat, M; Demirkan, B; Al-Buraiki, J; Karabsheh, S
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/372963
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