SPC365

Sacubitril-Valsartan versus ACEI in left ventricular reverse remodelling and cardiovascular outcomes

Session: Comunicações Orais (Sessão 20) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Tinoco; Ana Filipa Cardoso; Geraldo Dias; Tamara Pereira; Bebiana Faria; Filipa Almeida; Sérgio Leite; António Lourenço

<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background</span></span></span></span></strong></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">PARADIGM-HF demonstrated superiority of Sacubitril-Valsartan (SV) over enalapril in patients with heart failure with reduced ejection fraction (HFrEF). However, the results of SV in hard endpoints in patients treated in routine clinical practice is missing evidence.</span></span></span></span></p>

<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Purpose</span></span></span></span></strong></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">The aim of this study was to assess comparative effectiveness of SV vs ACEI on left ventricular reverse remodelling (LVRR) and in major adverse cardiovascular events (MACE).</span></span></span></span></p>

<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></span></span></strong></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We performed a retrospective study of patients with HFrEF observed at an HF clinic between Jan 2018 and Jun 2020, with a follow up period until Oct 2021. We defined LVRR as an absolute increase in LVEF&ge;10 and a relative decrease in indexed LV end-diastolic diameter of at least 10%. MACE was defined as composite of death from CV causes or hospitalization for HF. One-to-one propensity score matching was used.</span></span></span></span></p>

<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></span></span></strong></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">A total of 173 HFrEF patients were included, 90 (52%) and 83 (48%) adults treated with SV or ACEI, respectively. The final propensity-matched cohort included 72 pairs taking SV or ACEI: 78,5% (113) male, 64,19&plusmn;11,74 years, mean LVEF 26,01&plusmn;7,47% and median follow up (FUP) of 33 months (22,5-48,75).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">LVRR was observed more frequently in ACEI group than in SV group (38,9% vs 19,4%; P=0.017). The change in LVEF from baseline to FUP was greater in ACEI group than in SV group (15.05% vs 8.61%, P=0.016). ACEI increased the prevalence of LVEF &ge;40% at FUP (56,9% vs 33,3%; P=0.014).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">The components of CV outcomes all showed trends toward lower numbers of events with SV vs ACEI, but those were not statistically significant, possibly due to a low FUP. MACE occurred in 21(29,2%) patients treated with SV and in 26(36,1%) patients taking ACEI.&nbsp; During FUP, 11(15,3%) patients treated with SV died, compared with 17(23,6%) treated with ACEI. The proportion of CV mortality was 6(8,3%) for SV patients and 10(13,9%) for ACEI patients. HF hospitalization occurred in 18(25%) patients taking SV vs 20(28,6%) patients taking ACEI, of which 10(13,9%) and 7(9,9%), respectively, were rehospitalised for HF. &nbsp;</span></span></span></span></p>

<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></span></span></strong></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We observed an increased benefit of using ACEI over SV on recovery of LVEF. Despite this, treatment effect on CV outcomes of SV vs ACEI did not show a significant difference, however there is a trend for patients taking SV to have a reduction in MACE. Improvement in LVEF is an important marker, nonetheless it was not translated into an effective reduction in mortality or hospitalizations in this population.</span></span></span></span></p>