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Cardiovascular-kidney-metabolic overlap in heart failure with preserved ejection fraction: Cardiac structure and function, clinical outcomes, and response to sacubitril/valsartan in PARAGON-HF.
Lassen, Mats C H; Ostrominski, John W; Claggett, Brian L; Packer, Milton; Zile, Michael; Desai, Akshay S; Shah, Amil M; Cikes, Maja; Merkely, Bela; Gori, Mauro; Wang, Xiaowen; Hegde, Sheila M; Pfeffer, Marc A; Lefkowitz, Martin; McMurray, John J V; Solomon, Scott D; Vaduganathan, Muthiah.
Afiliación
  • Lassen MCH; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Ostrominski JW; Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
  • Claggett BL; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  • Packer M; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Zile M; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Desai AS; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Shah AM; Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.
  • Cikes M; RHJ Department of Veterans Affairs, Medical Center and Medical University of South Carolina, Charleston, SC, USA.
  • Merkely B; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Gori M; Division of Cardiovascular Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Wang X; Department for Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia.
  • Hegde SM; Semmelweis University Heart and Vascular Center, Budapest, Hungary.
  • Pfeffer MA; Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Lefkowitz M; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • McMurray JJV; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Solomon SD; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
  • Vaduganathan M; Novartis, East Hanover, Hanover, NJ, USA.
Eur J Heart Fail ; 26(8): 1762-1774, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38932589
ABSTRACT

AIMS:

Cardiovascular-kidney-metabolic (CKM) multimorbidity is prevalent among individuals with heart failure (HF), but whether cardiac structure and function, clinical outcomes, and treatment response to sacubitril/valsartan vary in relation to CKM status is unknown. METHODS AND

RESULTS:

In this PARAGON-HF post-hoc analysis, we evaluated the impact of CKM multimorbidity (atherosclerotic cardiovascular [CV] disease, chronic kidney disease, and type 2 diabetes) on cardiac structure and function, clinical outcomes, and treatment effects of sacubitril/valsartan versus valsartan. The primary outcome was a composite of total HF hospitalizations and CV death. Secondary outcomes included the individual components of the primary outcome and a composite kidney outcome (sustained estimated glomerular filtration rate reduction of ≥50%, end-stage kidney disease, or kidney-related death). At baseline, 35.2% had one CKM condition, 33.3% had two, 15.9% had three, and only 15.6% had HF alone. CKM multimorbidity was associated with higher septal and posterior wall thickness, lower global longitudinal strain, higher E/e', and worse right ventricular function. Total HF hospitalizations or CV death increased with greater CKM multimorbidity, with the highest relative risk observed with three CKM conditions (rate ratio 3.06, 95% confidence interval 2.33-4.03), compared with HF alone. Treatment effects of sacubitril/valsartan were consistent irrespective of the number of CKM conditions for the primary endpoint (pinteraction = 0.75), CV death (pinteraction = 0.82), total HF hospitalizations (pinteraction = 0.67), and the composite kidney endpoint (pinteraction = 0.99).

CONCLUSIONS:

Cardiovascular-kidney-metabolic multimorbidity was common in PARAGON-HF and associated with adverse changes in cardiac structure and function and with a stepwise increase in risk of clinical outcomes. Treatment effects of sacubitril/valsartan were consistent irrespective of CKM burden. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01920711.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Volumen Sistólico / Compuestos de Bifenilo / Combinación de Medicamentos / Antagonistas de Receptores de Angiotensina / Valsartán / Aminobutiratos / Insuficiencia Cardíaca Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Heart Fail Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Volumen Sistólico / Compuestos de Bifenilo / Combinación de Medicamentos / Antagonistas de Receptores de Angiotensina / Valsartán / Aminobutiratos / Insuficiencia Cardíaca Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Heart Fail Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido