Ying-Hsiang Lee1,2, Wei-Ru Chiou2,3, Chien-Yi Hsu4,5, Po-Lin Lin2,6, Huai-Wen Liang7, Fa-Po Chung4,8, Chia-Te Liao9, Wen-Yu Lin10, Hung-Yu Chang4,11. 1. Cardiovascular Center, MacKay Memorial Hospital, No. 9, Section 2, Zhongshan N Rd, Zhongshan District, Taipei City, 104 Taiwan. 2. Department of Medicine, Mackay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252 Taiwan. 3. Division of Cardiology, Taitung MacKay Memorial Hospital, No. 1, Lane 303, Zhangsha Street, Taitung City, Taitung County, 950 Taiwan. 4. Faculty of Medicine, School of Medicine, National Yang Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112 Taiwan. 5. Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, No. 252, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan. 6. Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City, 300 Taiwan. 7. Division of Cardiology, E-Da Hospital, No. 1, Yida Road, Yanchao District Kaohsiung City, 827 Taiwan. 8. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, 112 Taiwan. 9. Division of Cardiology, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan. 10. Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei City, 114, Taiwan. 11. Heart Center, Cheng Hsin General Hospital, No.45 Cheng-Hsin Street, 112 Beitou, Taipei, Taiwan.
Abstract
AIMS: Although the beneficial effect of sacubitril/valsartan (SAC/VAL) compared to enalapril was consistent across ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) groups, the PARADIGM-HF study did not analyse the effect of ventricular remodelling on patients with different aetiologies, which may affect clinical treatment outcomes. This study aimed to compare left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes. METHODS AND RESULTS: A total of 1576 patients were analysed. Patients were grouped by LVEF changes following SAC/VAL treatment for 8-month period. LVEF improvement ≥15% was defined as 'significant improvement', and <5% or worse was classified as 'lack of improvement'. The primary outcome was a composite of cardiovascular death and unplanned hospitalization for heart failure. Patients with NICM had lower baseline LVEF but improvement was significantly greater comparing to those with ICM (baseline 28.0 ± 7.7% vs. 30.1 ± 7.1%, P < 0.001, LVEF increase of 11.1 ± 12.6% vs. 6.7 ± 10.2%, P < 0.001). The effect of functional improvement of SAC/VAL on NICM patients showed bimodal distribution. Primary endpoints were inversely associated with LVEF changes in NICM patients: adjusted hazard ratio was 0.42 [95% confidence interval (CI) 0.31-0.58, P < 0.001] for NICM patients with significant improvement, and was 1.73 (95% CI 1.38-2.16, P < 0.001) for NICM patients but lack of improvement. Primary endpoints of ICM patients did not demonstrate an association with LVEF changes. CONCLUSION: Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients indicates favourable outcome. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Although the beneficial effect of sacubitril/valsartan (SAC/VAL) compared to enalapril was consistent across ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) groups, the PARADIGM-HF study did not analyse the effect of ventricular remodelling on patients with different aetiologies, which may affect clinical treatment outcomes. This study aimed to compare left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes. METHODS AND RESULTS: A total of 1576 patients were analysed. Patients were grouped by LVEF changes following SAC/VAL treatment for 8-month period. LVEF improvement ≥15% was defined as 'significant improvement', and <5% or worse was classified as 'lack of improvement'. The primary outcome was a composite of cardiovascular death and unplanned hospitalization for heart failure. Patients with NICM had lower baseline LVEF but improvement was significantly greater comparing to those with ICM (baseline 28.0 ± 7.7% vs. 30.1 ± 7.1%, P < 0.001, LVEF increase of 11.1 ± 12.6% vs. 6.7 ± 10.2%, P < 0.001). The effect of functional improvement of SAC/VAL on NICM patients showed bimodal distribution. Primary endpoints were inversely associated with LVEF changes in NICM patients: adjusted hazard ratio was 0.42 [95% confidence interval (CI) 0.31-0.58, P < 0.001] for NICM patients with significant improvement, and was 1.73 (95% CI 1.38-2.16, P < 0.001) for NICM patients but lack of improvement. Primary endpoints of ICM patients did not demonstrate an association with LVEF changes. CONCLUSION: Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients indicates favourable outcome. Published on behalf of the European Society of Cardiology. All rights reserved.
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