Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan
Abstract Aims A novel tool for the evaluation of left ventricular (LV) systo‐diastolic function through echo‐derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6 month treatment response to sacubitril/valsartan in hear...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14346 |
| _version_ | 1827795218363056128 |
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| author | Iacopo Fabiani Nicola Riccardo Pugliese Gianni Pedrizzetti Giovanni Tonti Vincenzo Castiglione Vladislav Chubuchny Claudia Taddei Alessia Gimelli Lavinia Del Punta Alessio Balletti Annamaria Del Franco Stefano Masi Carlo Mario Lombardi Matteo Cameli Michele Emdin Alberto Giannoni |
| author_facet | Iacopo Fabiani Nicola Riccardo Pugliese Gianni Pedrizzetti Giovanni Tonti Vincenzo Castiglione Vladislav Chubuchny Claudia Taddei Alessia Gimelli Lavinia Del Punta Alessio Balletti Annamaria Del Franco Stefano Masi Carlo Mario Lombardi Matteo Cameli Michele Emdin Alberto Giannoni |
| author_sort | Iacopo Fabiani |
| collection | DOAJ |
| description | Abstract Aims A novel tool for the evaluation of left ventricular (LV) systo‐diastolic function through echo‐derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6 month treatment response to sacubitril/valsartan in heart failure with reduced ejection fraction (HFrEF) patients and (ii) cardiovascular events. Methods and results Eighty‐nine consecutive HFrEF patients [70% males, 65 ± 9 years, LV ejection fraction (LVEF) 27 ± 7%] initiating sacubitril/valsartan underwent clinical, laboratory, ultrasound and cardiopulmonary exercise testing evaluations. Patients experiencing no adverse events and showing ≥50% reduction in plasma N‐terminal pro‐B‐type natriuretic peptide and/or ≥10% LVEF increase over 6 months were considered responders. Patients were followed up for the composite endpoint of HF‐related hospitalisation, atrial fibrillation and cardiovascular death. Forty‐five (51%) patients were responders. Among baseline variables, only HDF‐derived whole cardiac cycle LV strength (wLVS) was higher in responders (4.4 ± 1.3 vs. 3.6 ± 1.2; p = 0.01). wLVS was also the only independent predictor of sacubitril/valsartan response at multivariable logistic regression analysis [odds ratio 1.36; 95% confidence interval (CI) 1.10–1.67], with good accuracy at receiver operating characteristic (ROC) analysis [optimal cutpoint: ≥3.7%; area under the curve (AUC) = 0.736]. During a 33 month (23–41) median follow‐up, a wLVS increase after 6 months (ΔwLVS) showed a high discrimination ability at time‐dependent ROC analysis (optimal cut‐off: ≥0.5%; AUC = 0.811), stratified prognosis (log‐rank p < 0.0001) and remained an independent predictor for the composite endpoint (hazard ratio 0.76; 95% CI 0.61–0.95; p < 0.01), after adjusting for clinical and instrumental variables. Conclusions HDF analysis predicts sacubitril/valsartan response and might optimise decision‐making in HFrEF patients. |
| first_indexed | 2024-03-11T18:45:34Z |
| format | Article |
| id | doaj.art-4dd9533cb10f41c3ac980d3b37b09ea6 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-11T18:45:34Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-4dd9533cb10f41c3ac980d3b37b09ea62023-10-12T02:48:44ZengWileyESC Heart Failure2055-58222023-10-011052927293810.1002/ehf2.14346Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartanIacopo Fabiani0Nicola Riccardo Pugliese1Gianni Pedrizzetti2Giovanni Tonti3Vincenzo Castiglione4Vladislav Chubuchny5Claudia Taddei6Alessia Gimelli7Lavinia Del Punta8Alessio Balletti9Annamaria Del Franco10Stefano Masi11Carlo Mario Lombardi12Matteo Cameli13Michele Emdin14Alberto Giannoni15Fondazione Toscana Gabriele Monasterio Pisa ItalyDepartment of Clinical and Experimental Medicine University of Pisa Pisa ItalyDepartment of Engineering and Architecture University of Trieste Trieste ItalyDivision of Cardiology ‘G. D'Annunzio’ University Chieti ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyDepartment of Clinical and Experimental Medicine University of Pisa Pisa ItalyDepartment of Clinical and Experimental Medicine University of Pisa Pisa ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyDepartment of Clinical and Experimental Medicine University of Pisa Pisa ItalyDepartment of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Civil Hospital Brescia ItalyDepartment of Medical Biotechnologies, Division of Cardiology University of Siena Siena ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyAbstract Aims A novel tool for the evaluation of left ventricular (LV) systo‐diastolic function through echo‐derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6 month treatment response to sacubitril/valsartan in heart failure with reduced ejection fraction (HFrEF) patients and (ii) cardiovascular events. Methods and results Eighty‐nine consecutive HFrEF patients [70% males, 65 ± 9 years, LV ejection fraction (LVEF) 27 ± 7%] initiating sacubitril/valsartan underwent clinical, laboratory, ultrasound and cardiopulmonary exercise testing evaluations. Patients experiencing no adverse events and showing ≥50% reduction in plasma N‐terminal pro‐B‐type natriuretic peptide and/or ≥10% LVEF increase over 6 months were considered responders. Patients were followed up for the composite endpoint of HF‐related hospitalisation, atrial fibrillation and cardiovascular death. Forty‐five (51%) patients were responders. Among baseline variables, only HDF‐derived whole cardiac cycle LV strength (wLVS) was higher in responders (4.4 ± 1.3 vs. 3.6 ± 1.2; p = 0.01). wLVS was also the only independent predictor of sacubitril/valsartan response at multivariable logistic regression analysis [odds ratio 1.36; 95% confidence interval (CI) 1.10–1.67], with good accuracy at receiver operating characteristic (ROC) analysis [optimal cutpoint: ≥3.7%; area under the curve (AUC) = 0.736]. During a 33 month (23–41) median follow‐up, a wLVS increase after 6 months (ΔwLVS) showed a high discrimination ability at time‐dependent ROC analysis (optimal cut‐off: ≥0.5%; AUC = 0.811), stratified prognosis (log‐rank p < 0.0001) and remained an independent predictor for the composite endpoint (hazard ratio 0.76; 95% CI 0.61–0.95; p < 0.01), after adjusting for clinical and instrumental variables. Conclusions HDF analysis predicts sacubitril/valsartan response and might optimise decision‐making in HFrEF patients.https://doi.org/10.1002/ehf2.14346Haemodynamic forcesHeart failure with reduced ejection fractionPrognosisSacubitril/valsartan |
| spellingShingle | Iacopo Fabiani Nicola Riccardo Pugliese Gianni Pedrizzetti Giovanni Tonti Vincenzo Castiglione Vladislav Chubuchny Claudia Taddei Alessia Gimelli Lavinia Del Punta Alessio Balletti Annamaria Del Franco Stefano Masi Carlo Mario Lombardi Matteo Cameli Michele Emdin Alberto Giannoni Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan ESC Heart Failure Haemodynamic forces Heart failure with reduced ejection fraction Prognosis Sacubitril/valsartan |
| title | Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan |
| title_full | Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan |
| title_fullStr | Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan |
| title_full_unstemmed | Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan |
| title_short | Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan |
| title_sort | haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril valsartan |
| topic | Haemodynamic forces Heart failure with reduced ejection fraction Prognosis Sacubitril/valsartan |
| url | https://doi.org/10.1002/ehf2.14346 |
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