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Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes.

Publication ,  Journal Article
Khan, MS; Felker, GM; Piña, IL; Camacho, A; Bapat, D; Ibrahim, NE; Maisel, AS; Prescott, MF; Ward, JH; Solomon, SD; Januzzi, JL; Butler, J
Published in: JACC Heart Fail
February 2021

OBJECTIVE: This study sought to determine whether patients with heart failure and reduced ejection fraction (HFrEF) with type 2 diabetes mellitus (T2DM) have similar reverse cardiac remodeling with sacubitril/valsartan as patients without T2DM. BACKGROUND: Sacubitril/valsartan promotes reverse cardiac remodeling and improves outcomes in patients with HFrEF. Patients with HFrEF with T2DM have worse prognosis than those without T2DM. METHODS: In this post hoc analysis of PROVE-HF (Prospective Study of Biomarkers, Symptom Improvement, and Ventricular Remodeling During Sacubitril/Valsartan Therapy for Heart Failure), we examined changes in N-terminal pro-b-type natriuretic peptide (NT-proBNP), measures of cardiac remodeling, and Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) scores from baseline to 12 months following initiation of sacubitril/valsartan between patients with HFrEF with and without T2DM. Using latent growth curve modeling, we evaluated the longitudinal association between changes in NT-proBNP, left ventricular ejection fraction, and KCCQ-OS. RESULTS: Among 794 patients enrolled, 361 (45.5%) had T2DM. NT-proBNP concentrations were modestly higher at baseline among patients with T2DM but were reduced after initiation of sacubitril/valsartan. Cross-sectional improvement was observed in left ventricular ejection fraction (T2DM: 28.3% at baseline and 37% at 12 months vs. non-T2DM: 28.1% at baseline and 38.3% at 12 months) and KCCQ-OS (T2DM: 71 at baseline and 83 at 12 months vs. non-T2DM: 76 at baseline and 88 at 12 months). Similar changes were also observed for other echocardiographic measures. In longitudinal analyses, the average NT-proBNP change was similar in patients with T2DM (-5.6% vs. -7.1% per 90-day interval; p = 0.64), whereas improvements in KCCQ-OS scores were slightly smaller (2.1 vs. 3.46 per 90-day interval; p = 0.07). CONCLUSIONS: Sacubitril/valsartan favorably affects natriuretic peptide levels, reverse cardiac remodeling, and health status in patients with HFrEF with and without T2DM. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

February 2021

Volume

9

Issue

2

Start / End Page

137 / 145

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • Valsartan
  • Stroke Volume
  • Prospective Studies
  • Humans
  • Heart Failure
  • Drug Combinations
  • Diabetes Mellitus, Type 2
  • Cross-Sectional Studies
 

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Khan, M. S., Felker, G. M., Piña, I. L., Camacho, A., Bapat, D., Ibrahim, N. E., … Butler, J. (2021). Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes. JACC Heart Fail, 9(2), 137–145. https://doi.org/10.1016/j.jchf.2020.09.014
Khan, Muhammad Shahzeb, G Michael Felker, Ileana L. Piña, Alexander Camacho, Devavrat Bapat, Nasrien E. Ibrahim, Alan S. Maisel, et al. “Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes.JACC Heart Fail 9, no. 2 (February 2021): 137–45. https://doi.org/10.1016/j.jchf.2020.09.014.
Khan MS, Felker GM, Piña IL, Camacho A, Bapat D, Ibrahim NE, et al. Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes. JACC Heart Fail. 2021 Feb;9(2):137–45.
Khan, Muhammad Shahzeb, et al. “Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes.JACC Heart Fail, vol. 9, no. 2, Feb. 2021, pp. 137–45. Pubmed, doi:10.1016/j.jchf.2020.09.014.
Khan MS, Felker GM, Piña IL, Camacho A, Bapat D, Ibrahim NE, Maisel AS, Prescott MF, Ward JH, Solomon SD, Januzzi JL, Butler J. Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes. JACC Heart Fail. 2021 Feb;9(2):137–145.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

February 2021

Volume

9

Issue

2

Start / End Page

137 / 145

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • Valsartan
  • Stroke Volume
  • Prospective Studies
  • Humans
  • Heart Failure
  • Drug Combinations
  • Diabetes Mellitus, Type 2
  • Cross-Sectional Studies