Structural abnormalities and effects of sacubitril/valsartan in patients with mildly reduced or preserved ejection fraction and worsening heart failure: The PARAGLIDE-HF trial - 26/07/25
, Derek D. Cyr, PhD a, Josephine Harrington, MD c, d, Anuradha Lala, MD e, Marat Fudim, MD, MHS a, b, Jonathan H. Ward, PharmD f, Samiha Sarwat, PhD f, Scott D. Solomon, MD g, Adrian F. Hernandez, MD, MHS a, b, Shelley Zieroth, MD h, Randall C. Starling, MD, MPH i, Robert J. Mentz, MD a, bHighlights |
• | While structural abnormalities are common, approximately three-quarters of the PARAGLIDE-HF population exhibited such abnormalities, as evidenced by left ventricular hypertrophy (LVH) and left atrial enlargement (LAE). |
• | There was no difference in either baseline NT-proBNP or changes in NT-proBNP over time, nor was there a difference in the time to the first cardiovascular composite event across varying degrees of structural abnormalities. |
• | A greater reduction in NT-proBNP with sacubitril/valsartan vs valsartan was consistent across all structural abnormality groups. |
• | There was no significant interaction between treatment and degree of structural abnormalities for other efficacy endpoints, but patients with both LVH and LAE had significantly higher odds of hyperkalemia with sacubitril/valsartan. |
ABSTRACT |
Background |
PARAGLIDE-HF showed significantly greater reduction in NT-proBNP in patients with LVEF>40% and worsening HF with sacubitril/valsartan (sac/val) vs valsartan (val). The impact of structural abnormalities on the effects of sac/val in this context is unknown. This study aimed to evaluate the impact of left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) on sac/val in patients with LVEF>40% and worsening HF.
Methods |
PARAGLIDE-HF patients were classified into 3 groups according the degree of structural abnormalities using LVH and LAE. The primary endpoint was time-averaged proportional change in NT-proBNP from baseline to Weeks 4 and 8. Secondary endpoints were recurrent cardiovascular composite events (HF hospitalizations, urgent HF visits, cardiovascular death) and adverse events (symptomatic hypotension, hyperkalemia, worsening renal function).
Results |
Of 454 (97.4%) patients with LVH and LAE data, 157 (34.5%) had both LVH and LAE, 178 (39.2%) had either LVH or LAE, and 119 (26.2%) had neither LVH nor LAE. Greater reduction in NT-proBNP with sac/val vs val was consistent across groups ( P interaction = 0.705). There was no significant interaction between treatment and degree of structural abnormalities for other efficacy endpoints. Patients with both LVH and LAE had significantly higher odds of hyperkalemia with sac/val (OR 2.41, P interaction = 0.024).
Conclusion |
Patients with LVEF>40% and recent WHF had greater reduction in NT-proBNP with sac/val vs val, regardless of the degree of structural abnormalities. There was no difference in the effects of sac/val on efficacy endpoints across structural abnormality group. Patients with both LVH and LAE had higher odds for hyperkalemia with sac/val.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Prevalence and impact of structural abnormalities on the effects of sacubitril/valsartan in patients with LVEF > 40% and a recent worsening heart failure event
Plan
Vol 289
P. 105-116 - novembre 2025 Retour au numéro
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