Pablo Díez-Villanueva1, Lourdes Vicent2, Francisco de la Cuerda3, Alberto Esteban-Fernández4, Manuel Gómez-Bueno5, Javier de Juan-Bagudá6, Ángel Manuel Iniesta7, Ana Ayesta8, Antonio Rojas-González3, Ramón Bover-Freire9, Diego Iglesias10, Marcos García-Aguado5, Jesús Ángel Perea-Egido11, Jorge Salamanca3, Manuel Martínez-Sellés2,12. 1. Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain, pablo_diez_villanueva@hotmail.com. 2. Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain. 3. Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain. 4. Servicio de Cardiología Hospital Universitario de Móstoles, Madrid, Spain. 5. Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain. 6. Servicio de Cardiología, Hospital Universitario Doce de Octubre, Madrid, Spain. 7. Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. 8. Servicio de Cardiología, Hospital del Sureste, Arganda del Rey, Madrid, Spain. 9. Servicio de Cardiología, Hospital Universitario Clínico de San Carlos, Madrid, Spain. 10. Servicio de Cardiología, Hospital Infanta Sofía, Madrid, Spain. 11. Servicio de Cardiología, Hospital de Getafe, Madrid, Spain. 12. Universidad Complutense, Universidad Europea, Madrid, Spain.
Abstract
BACKGROUND: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. METHODS: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). RESULTS: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). CONCLUSIONS: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.
BACKGROUND: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. METHODS: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). RESULTS: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13-0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). CONCLUSIONS: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.