期刊
JACC-HEART FAILURE
卷 10, 期 5, 页码 336-346出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2022.01.018
关键词
atrial fibrillation; echocardiography; heart failure outcomes; heart failure with preserved ejection fraction; sacubitril; valsartan
The study found that a history of AFF and presence of AFF at enrollment were associated with a higher risk of adverse outcomes in HFpEF patients. Additionally, first-detected AFF was not influenced by sacubitril/valsartan treatment, but was linked to increased risk of subsequent outcomes.
OBJECTIVES In this study, the authors sought to assess the relationship between AFF and outcomes, the treatment response to sacubitril/valsartan and first-detected AFF in patients with HFpEF enrolled in the PARAGON-HF trial. BACKGROUND Atrial fibrillation and flutter (AFF) are common in heart failure with preserved ejection fraction (HFpEF) and increase the risk of adverse outcomes. METHODS A total of 4,776 patients formed 3 groups: those with AFF according to electrocardiography (ECG) at enrollment (n =1,552; 33%), those with history of AFF but without AFF on ECG at enrollment (n =1,005; 21%), and those without history of AFF or AFF on ECG at enrollment (n = 2,219, 46%). We assessed outcomes, treatment response to sacubitril/valsartan in each group, and the risk associated with first-detected AFF in patients without any known AFF. The primary outcome was a composite of total heart failure hospitalizations and cardiovascular death. RESULTS History of AFF and AFF at enrollment were associated with higher risk of the primary outcome (risk ratio [RR]: 1.36 [95% CI: 1.12-1.65] and RR: 1.31 [1.11-1.54], respectively), than no AFF. Neither history of AFF nor AFF at enrollment modified the treatment effect of sacubitril/valsartan. Post randomization AFF occurred in 12% of patients without previous AFF and was associated with 2.8-fold higher risk of the primary outcome, but it was not influenced by sacubitril/ valsartan. CONCLUSIONS History of AFF and AFF on ECG at enrollment were associated with a higher risk of the primary outcome. First-detected AFF was not influenced by sacubitril/valsartan, yet it was associated with increased risk of all subsequent outcomes and may represent a potential target for future HFpEF trials. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711) (J Am Coll Cardiol HF 2022;10:336-346) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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