Circulating neprilysin hypothesis : A new opportunity for sacubitril/valsartan in patients with heart failure and preserved ejection fraction?
Lupón, Josep (Universitat Autònoma de Barcelona. Departament de Medicina)
Santiago Vacas, Evelyn (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cediel, Germán (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Codina, Pau (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Domingo, Mar (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Revuelta-López, Elena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Zamora, Elisabet (Universitat Autònoma de Barcelona. Departament de Medicina)
Spitaleri, Giosafat (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Santesmases, Javier (Universitat Autònoma de Barcelona. Departament de Medicina)
Núñez, Julio (Universitat de València. Departament de Medicina)
Bayés-Genís, Antoni (Universitat Autònoma de Barcelona. Departament de Medicina)

Date:	2021
Abstract:	Circulating Neprilysin (sNEP) has emerged as a potential prognostic biomarker in heart failure (HF). In PARAGON-HF benefit of sacubitril/valsartan was only observed in patients with left ventricular ejection fraction (LVEF) ≤57%. We aimed to assess the prognostic value of sNEP in outpatients with HF and LVEF >57%, in comparison with patients with LVEF ≤57%. Consecutive HF outpatients were included from May-2006 to February-2016. The primary endpoint was the composite of all-cause death or HF hospitalization and the main secondary endpoint was the composite of cardiovascular death or HF hospitalization. For the later competing risk methods were used. sNEP was measured in 1428 patients (age 67. 7±12. 7, 70. 3% men, LVEF 35. 8% ±14), 144 of which had a LVEF >57%. sNEP levels did not significantly differ between LVEF groups (p = 0. 31). During a mean follow-up of 6±3. 9 years, the primary endpoint occurred in 979 patients and the secondary composite endpoint in 714 (in 111 and 84 of the 144 patients with LVEF >57%, respectively). sNEP was significantly associated with both composite endpoints. Age- and sex- adjusted Cox regression analyses showed higher hazard ratios for sNEP in patients with LVEF >57%, both for the primary (HR 1. 37 [1. 16-1. 61] vs. 1. 04 [0. 97-1. 11]) and the secondary (HR 1. 38 [1. 21-1. 55] vs. 1. 11 [1. 04-1. 18]) composite endpoints. sNEP prognostic value in patients with HF and LVEF >57% outperforms that observed in patients with lower LVEF. Precision medicine using sNEP may identify HF patients with preserved LVEF that may benefit from treatment with sacubitril/valsartan.
Grants:	Ministerio de Economía y Competitividad RD12/0042/0047
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	PloS one, Vol. 16 (may 2021) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0249674
PMID: 33989294

10 p, 744.9 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles