期刊
JACC-HEART FAILURE
卷 9, 期 2, 页码 127-136出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2020.09.013
关键词
ANP; cardiac remodeling; HFrEF; sacubitril/valsartan
资金
- Novartis Pharmaceuticals, Inc.
- Hutter Family Professorship
- National Heart, Lung, and Blood Institute
- American Heart Association
- Merck
- Cytokinetics
- Roche Diagnostics
- National Institutes of Health
- Patient-Centered Outcomes Research Institute
- European Union
- Alnylam
- AstraZeneca
- Bellerophon
- Bayer
- Bristol Myers Squibb
- Celladon
- Eidos
- Gilead
- GlaxoSmithKline
- Ionis
- Lone Star Heart
- Mesoblast
- MyoKardia
- National Institute of Health/National Heart, Lung, and Blood Institute
- Novartis
- Sanofi Pasteur
- Theracos
- Novartis Pharmaceuticals
- Abbott Diagnostics
- Amgen
This study found that concentrations of ANP doubled after initiation of sacubitril/valsartan in patients with HFrEF. Larger early increases in ANP were associated with a greater magnitude of subsequent reverse cardiac remodeling.
OBJECTIVES This study sought to assess associations between longitudinal change in atrial natriuretic peptide (ANP) and reverse cardiac remodeling following initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND Neprilysin inhibition results in an increase of several vasoactive peptides that may mediate the beneficial effects of sacubitril/valsartan, including ANP. METHODS In a prospective study of initiation and titration of sacubitril/valsartan in patients with HFrEF, blood was collected at scheduled time points into tubes containing protease inhibitors. This pre-specified exploratory analysis included patients in whom ANP was measured at baseline and serially through 12 months of treatment. RESULTS Among 144 participants (mean age: 64.5 years; left ventricular ejection fraction: 30.8%), following initiation of sacubitril/valsartan, there was an early and significant increase in ANP, with the majority of rise from 99 pg/mt at baseline to 156 pg/mt at day 14 (p < 0.001). There was a further trend toward a second increase from day 30 to day 45 (p = 0.07). At maximal rise, ANP had doubted. In longitudinal analyses, early rise in ANP was followed by a subsequent increase in urinary cycle guanosine monophosphate. Larger early increase in ANP was associated with larger later improvements in left ventricular ejection fraction and left atrial volume index (p < 0.001 for both). CONCLUSIONS Concentrations of ANP doubted after initiation of sacubitrit/vatsartan in patients with HFrEF. Larger early increases in ANP were associated with a greater magnitude of subsequent reverse cardiac remodeling. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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