Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan
Articolo
Data di Pubblicazione:
2022
Citazione:
Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan / F.L. Dini, E. Carluccio, R. Bitto, M. Ciccarelli, M. Correale, A. D'Agostino, G. Dattilo, M. Ferretti, A. Grelli, S. Guida, F. Jacoangeli, L. Lupi, L. Luschi, D. Masarone, V. Mercurio, G. Pacileo, N.R. Pugliese, A. Rispoli, L. Scelsi, C.G. Tocchetti, N.D. Brunetti, A. Palazzuoli, M. Piepoli, S. Nodari, G. Ambrosio. - In: ESC HEART FAILURE. - ISSN 2055-5822. - 9:2(2022), pp. 1107-1117. [10.1002/EHF2.13779]
Abstract:
Aim Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) corre-
lates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prog-
nostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting
sacubitril/valsartan.
Methods and results In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the
combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m 2
) and early transmitral Doppler velocity/early diastolic
annular velocity ratio (E/e′: ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Pro-
file-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and
followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable
Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had
more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely
reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year)
progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-
adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding
this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improve-
ment (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event’s risk independently of
haemodynamic profile.
Conclusions Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different
risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemody-
namic profiles.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
ejection fraction; haemodynamic; heart failure; prognosis; sacubitril/valsartan
Elenco autori:
F.L. Dini, E. Carluccio, R. Bitto, M. Ciccarelli, M. Correale, A. D'Agostino, G. Dattilo, M. Ferretti, A. Grelli, S. Guida, F. Jacoangeli, L. Lupi, L. Luschi, D. Masarone, V. Mercurio, G. Pacileo, N.R. Pugliese, A. Rispoli, L. Scelsi, C.G. Tocchetti, N.D. Brunetti, A. Palazzuoli, M. Piepoli, S. Nodari, G. Ambrosio
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