Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 74, Issue 23, Pages 2858-2873Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2019.09.063
Keywords
diastolic function; echocardiography; heart failure; preserved left ventricular function
Categories
Funding
- Novartis
- National Heart, Lung, and Blood Institute [K08HL116792, R01HL135008, R01HL143224]
- Watkins Discovery Award from the Brigham and Women's Heart and Vascular Center
- Novartis through Brigham and Women's Hospital
- GE Healthcare
- Abbott
- Roche Diagnostics
- Bayer
- Pfizer
- Boehringer Ingelheim
- Berlin-Chemie Menarini
- Servier
- Corvia
- AstraZeneca
- Sanofi Genzyme
- Sandoz
- Amgen
- Orion Pharma
- Teva Pharmaceutical Industries
- CVRx
- Medtronic
- Boston Scientific
- Vifor Pharma
- Merck
- American Regent
- National Institutes of Health [R01 HL107577, R01 HL127028, R01 HL140731, R01 HL149423]
- Actelion
- Alnylam
- Bellerophon
- BMS
- Celladon
- Cytokinetics
- Eidos
- Gilead
- GSK
- Ionis
- Lone Star Heart
- Mesoblast
- MyoKardia
- NIH/NHLBI
- Sanofi Pasteur
- Theracos
Ask authors/readers for more resources
BACKGROUND The PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction) trial tested the efficacy of sacubitril-valsartan in patients with heart failure with preserved ejection fraction (HFpEF). Existing data on cardiac structure and function in patients with HFpEF suggest significant heterogeneity. OBJECTIVES The aim of this study was to characterize cardiac structure and function, quantify their associations with clinical outcomes, and contextualize these findings with other HFpEF studies. METHODS Echocardiography was performed in 1,097 of 4,822 PARAGON-HF patients within 6 months of enrollment. Associations with incident first heart failure hospitalization or cardiovascular death were assessed using Cox proportional hazards models adjusted for age, sex, region of enrollment, randomized treatment, N-terminal pro-brain natriuretic peptide, and clinical risk factors. RESULTS Average age was 74 +/- 8 years, 53% of patients were women, median N-terminal pro-brain natriuretic peptide level was 918 pg/ml (interquartile range: 485 to 1,578 pg/ml), 94% had hypertension, and 35% had atrial fibrillation. The mean left ventricular (LV) ejection fraction was 58.6 +/- 9.8%, prevalence of LV hypertrophy was 21%, prevalence of left atrial enlargement was 83%, prevalence of elevated E/e' ratio was 53%, and prevalence of pulmonary hypertension was 31%. Heart failure hospitalization or cardiovascular death occurred in 288 patients at 2.8-year median follow-up. In fully adjusted models, higher LV mass index (hazard ratio [HR]: 1.05 per 10 g/m(2); 95% confidence interval [CI]: 1.00 to 1.10; p = 0.03), E/e' ratio (HR: 1.04 per unit; 95% CI: 1.02 to 1.06; p < 0.001), pulmonary artery systolic pressure (HR: 1.51 per 10 mm Hg; 95% CI: 1.29 to 1.76; p < 0.001), and right ventricular end-diastolic area (HR: 1.04 per cm(2); 95% CI: 1.01 to 1.07; p = 0.003) were each associated with this composite, while LV ejection fraction and left atrial size were not (p > 0.05 for all). Appreciable differences were observed in cardiac structure compared with other HFpEF clinical trials, despite similar E/e' ratio, pulmonary artery systolic pressure, and event rates. CONCLUSIONS Diastolic dysfunction, left atrial enlargement, and pulmonary hypertension were common in PARAGON-HF. LV hypertrophy, elevated left- and right-sided pressures, and right ventricular enlargement were independently predictive of incident heart failure hospitalization or cardiovascular death. Echocardiographic differences among HFpEF trials despite similar clinical event rates highlight the heterogeneity of this syndrome. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711) (C) 2019 by the American College of Cardiology Foundation.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available