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Atrial Natriuretic Peptide and Treatment With Sacubitril/Valsartan in Heart Failure With Reduced Ejection Fraction
- Source :
- JACC: Heart Failure. 9:127-136
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- 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).Neprilysin inhibition results in an increase of several vasoactive peptides that may mediate the beneficial effects of sacubitril/valsartan, including ANP.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.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/ml at baseline to 156 pg/ml 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 doubled. 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).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. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183).
- Subjects :
- medicine.medical_specialty
Tetrazoles
030204 cardiovascular system & hematology
Ventricular Function, Left
Sacubitril
Angiotensin Receptor Antagonists
03 medical and health sciences
0302 clinical medicine
Atrial natriuretic peptide
Internal medicine
medicine
Humans
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Neprilysin
Heart Failure
Ejection fraction
business.industry
Aminobutyrates
Biphenyl Compounds
Stroke Volume
Middle Aged
medicine.disease
Drug Combinations
Treatment Outcome
Valsartan
Heart failure
cardiovascular system
Cardiology
Cardiology and Cardiovascular Medicine
business
Atrial Natriuretic Factor
Sacubitril, Valsartan
medicine.drug
Subjects
Details
- ISSN :
- 22131779
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- JACC: Heart Failure
- Accession number :
- edsair.doi.dedup.....2352925ccb8ce85ed935e3591bc7650a