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Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan.

Publication ,  Journal Article
Mohebi, R; Liu, Y; Felker, GM; Prescott, MF; Piña, IL; Butler, J; Ward, JH; Solomon, SD; Januzzi, JL
Published in: JACC Heart Fail
January 2023

BACKGROUND: Sacubitril/valsartan (Sac/Val) improves left ventricular ejection fraction (LVEF) in heart failure (HF) with reduced ejection fraction regardless of previous treatments. Improvements in LVEF may change eligibility for primary implantable cardioverter-defibrillator (ICD) placement. Awaiting LVEF improvement may expose patients to potential risks for arrhythmic complications. OBJECTIVES: The authors sought to develop a model predicting LVEF change after Sac/Val therapy. METHODS: A total of 416 persons with HF and LVEF of <35% were included in this analysis. Following initiation of Sac/Val, echocardiographic parameters were measured serially for 1 year. A machine learning algorithm was implemented to develop a risk model for predicting the persistence of LVEF of <35% after 1 year and was validated in a separate group of study participants. RESULTS: Baseline LVEF, left ventricular mass index, HF duration, age, N-terminal pro-B-type natriuretic peptide concentration at baseline and change by day 14, and body mass index were the most significant factors for identifying lack of LVEF improvement to ≥35% after 1 year. In the training and validation cohorts, the areas under the model curve for predicting lack of LVEF improvement were 0.92 and 0.86, respectively. Three categories of likelihood for LVEF of <35% after 1 year of Sac/Val treatment were developed based on the model predictions: 3.8%, 30.1%, and 83.7%. During follow-up, arrhythmia event rates were 0.9%, 2.9%, and 6.7% in these groups, respectively. CONCLUSIONS: Many persons with HF with reduced ejection fraction eligible for ICD insertion experience an increase in LVEF to ≥35% after treatment with Sac/Val. Early identification of those less likely to improve their LVEF might allow for more refined selection of primary ICD candidates. (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

January 2023

Volume

11

Issue

1

Start / End Page

44 / 54

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Valsartan
  • Stroke Volume
  • Humans
  • Heart Failure
  • Drug Combinations
  • Angiotensin Receptor Antagonists
  • Aminobutyrates
  • 3201 Cardiovascular medicine and haematology
 

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Mohebi, R., Liu, Y., Felker, G. M., Prescott, M. F., Piña, I. L., Butler, J., … Januzzi, J. L. (2023). Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan. JACC Heart Fail, 11(1), 44–54. https://doi.org/10.1016/j.jchf.2022.09.009
Mohebi, Reza, Yuxi Liu, G Michael Felker, Margaret F. Prescott, Ileana L. Piña, Javed Butler, Jonathan H. Ward, Scott D. Solomon, and James L. Januzzi. “Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan.JACC Heart Fail 11, no. 1 (January 2023): 44–54. https://doi.org/10.1016/j.jchf.2022.09.009.
Mohebi R, Liu Y, Felker GM, Prescott MF, Piña IL, Butler J, et al. Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan. JACC Heart Fail. 2023 Jan;11(1):44–54.
Mohebi, Reza, et al. “Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan.JACC Heart Fail, vol. 11, no. 1, Jan. 2023, pp. 44–54. Pubmed, doi:10.1016/j.jchf.2022.09.009.
Mohebi R, Liu Y, Felker GM, Prescott MF, Piña IL, Butler J, Ward JH, Solomon SD, Januzzi JL. Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan. JACC Heart Fail. 2023 Jan;11(1):44–54.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

January 2023

Volume

11

Issue

1

Start / End Page

44 / 54

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Valsartan
  • Stroke Volume
  • Humans
  • Heart Failure
  • Drug Combinations
  • Angiotensin Receptor Antagonists
  • Aminobutyrates
  • 3201 Cardiovascular medicine and haematology