Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan
Year: 2022
Type: article
Abstract: BACKGROUND: Sacubitril/valsartan (Sac/Val) improves left ventricular ejection fraction (LVEF) in heart failure (HF) with reduced ejection fraction regardless of previous treatments. Improvements in LVEF may change eligibility for primary implantable cardioverter-defibrillator (ICD) placement. Awaiting LVEF improvement may expose patients to potential risks for arrhythmic complications. OBJECTIVES: The authors sought to develop a model predicting LVEF change after Sac/Val therapy. METHODS: A total of 416 persons with HF and LVEF of <35% were included in this analysis. Following initiation of Sac/Val, echocardiographic parameters were measured serially for 1 year. A machine learning algorithm was implemented to develop a risk model for predicting the persistence of LVEF of <35% after 1 year and was validated in a separate group of study participants. RESULTS: Baseline LVEF, left ventricular mass index, HF duration, age, N-terminal pro-B-type natriuretic peptide concentration at baseline and change by day 14, and body mass index were the most significant factors for identifying lack of LVEF improvement to ≥35% after 1 year. In the training and validation cohorts, the areas under the model curve for predicting lack of LVEF improvement were 0.92 and 0.86, respectively. Three categories of likelihood for LVEF of <35% after 1 year of Sac/Val treatment were developed based on the model predictions: 3.8%, 30.1%, and 83.7%. During follow-up, arrhythmia event rates were 0.9%, 2.9%, and 6.7% in these groups, respectively. CONCLUSIONS: Many persons with HF with reduced ejection fraction eligible for ICD insertion experience an increase in LVEF to ≥35% after treatment with Sac/Val. Early identification of those less likely to improve their LVEF might allow for more refined selection of primary ICD candidates. (Effects of Sacubitril/Valsartan Therapy on biomarkers, Myocardial Remodeling, and Outcomes [PROVE-HF]; NCT02887183).
Source: JACC Heart Failure
Institutions: Harvard University, Massachusetts General Hospital, Duke Medical Center, Duke Clinical Research Institute, United States Food and Drug Administration, Center for Devices and Radiological Health, Central Michigan University, Case Western Reserve University, University of Mississippi Medical Center, Baylor Scott & White Health, Brigham and Women's Hospital, Baim Institute for Clinical Research
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,000
Funders: American Heart Association, Amgen, Eli Lilly and Company, AstraZeneca, GlaxoSmithKline, Merck, Novartis, Sanofi, Medtronic, Gilead Sciences, Alnylam Pharmaceuticals, Novartis Pharmaceuticals Corporation, Celladon Corporation, Ironwood Pharmaceuticals, Incorporated, LivaNova, Cytokinetics, MyoKardia, Impulse Dynamics, Novo Nordisk, National Institutes of Health, Abbott Diagnostics, Sanofi Pasteur, American Regent, Relypsa, National Heart, Lung, and Blood Institute
OpenAlex ID: W4308741742