scholarly journals Heart failure with improved ejection fraction: A review and pooled analysis of pathophysiology, diagnosis and clinical management

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Aref Albakri
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Management ◽  
Pooled Analysis

Abstract 17063: Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Finnian R Mc Causland ◽  
Marty Lefkowitz ◽  
Brian Claggett ◽  
Nagesh Anavekar ◽  
MICHELE SENNI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pooled Analysis ◽  
Renal Outcome ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition ◽  
Valsartan Group ◽  
Stage Renal Disease ◽  
End Stage ◽  
Enalapril Group

Background: In patients with heart failure, chronic kidney disease (CKD) is associated with a higher risk of renal events than in patients without CKD, irrespective of the ejection fraction. We assessed the renal effects of angiotensin/neprilysin inhibition in patients with heart failure in a pooled analysis of 13,195 patients with reduced and preserved ejection fraction. Methods: We combined data from PARADIGM-HF (LVEF eligibility≤40%; n=8,399) and PARAGON-HF (LVEF eligibility≥45%; n=4,796) in a prespecified pooled analysis. We assessed the effect of treatment (sacubitril/valsartan compared with enalapril or valsartan) on the renal composite outcome, defined as the time to first occurrence of either: ≥50% reduction in eGFR, end-stage renal disease, or death from renal causes. We also assessed the influence of therapy on eGFR slope. Results: At randomization, eGFR was 68±20 ml/min/1.73m 2 in PARADIGM-HF and 63±19 ml/min/1.73m 2 in PARAGON-HF. The composite renal outcome occurred in 70 of the 6594 patients (1.1%) in the sacubitril/valsartan group and 123 of the 6601 patients (1.9%) in the valsartan or enalapril group, with a risk reduction of 44% (HR 0.56, 95%CI 0.42-0.75; P<0.001). The treatment effect on the composite renal endpoint did not differ according to the baseline eGFR (<60 vs ≥ 60 ml/min/1.73 m 2 ; P-interaction=0.46) or baseline ejection fraction (P-interaction=0.35). From randomization, the mean decline in eGFR was -1.8 (95%CI -1.9 to -1.7) ml/min/1.73 m 2 per year for the sacubitril/valsartan group, compared with -2.4 (95%CI -2.5 to -2.2) ml/min/1.73 m 2 per year for the valsartan or enalapril group, with an adjusted mean difference of 0.6 (95%CI 0.4 to 0.7; P<0.001) ml/min/1.73 m 2 per year. Conclusions: In patients with heart failure, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, compared with valsartan or enalapril, across the spectrum of ejection fraction.

Acute heart failure with preserved ejection fraction and long-term Readmisions

2008 ◽  
Vol 7 ◽  
pp. 62-63
Author(s):  
J NUNEZ ◽  
L MAINAR ◽  
G MINANA ◽  
R ROBLES ◽  
J SANCHIS ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Preserved Ejection Fraction
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