{"id":"fbb1648662d7","type":"article","url":"https://hartvaat.nl/2022/10/18/dosisrespons-van-sacubitril-valsartan-bij-hfref/","title":"Dosisrespons van sacubitril/valsartan bij HFrEF","title_en":"Dose-Response to Sacubitril/Valsartan in Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.737","source_url":"https://doi.org/10.1016/j.jacc.2022.08.737","authors":["Reza Mohebi","Yuxi Liu","Ileana L Piña","Margaret F Prescott","Javed Butler","G Michael Felker","Jonathan H Ward","Scott D Solomon","James L Januzzi"],"significance":7,"published":"2022-10-18","source_date":"2022-10-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This study showed that even lower-than-target doses of sacubitril-valsartan provide meaningful clinical benefit in HFrEF, with a dose-response relationship where any dose is better than no exposure. The finding supports initiating ARNI therapy even when target dose cannot be achieved.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de dosisrespons van sacubitril/valsartan bij HFrEF. Zelfs lagere doses dan de in trials gebruikte doelsdosis gaven een klinisch voordeel, hoewel de hogere dosis superieur was. Dit ondersteunt het starten van sacubitril/valsartan ook als de volle dosis niet haalbaar is.","abstract_original":"BACKGROUND: Doses of sacubitril/valsartan (Sac/Val) achieved in clinical trials of heart failure with reduced ejection fraction (HFrEF) are often not reached in clinical practice. OBJECTIVES: The purpose of this study was to investigate associations among Sac/Val doses and changes in prognostic biomarkers, health status, and cardiac remodeling among individuals with HFrEF through 12 months of treatment with Sac/Val administered per usual care. METHODS: A total of 794 persons with HFrEF (ejection fraction [EF] ≤40%) were categorized according to average daily doses of Sac/Val divided into tertiles. Change from baseline to 12 months in biomarkers (N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, soluble ST2, atrial natriuretic peptide, urinary cyclic guanosine monophosphate), Kansas City Cardiomyopathy Questionnaire-23 scores, and parameters of cardiac reverse remodeling (left ventricular EF, indexed left atrial and ventricular volumes, and E/e') were assessed. RESULTS: The average daily dose was 112 mg in Tertile 1 (low dose), 342 mg in Tertile 2 (moderate dose), and 379 mg in Tertile 3 (high dose). Similar changes in prognostic biomarkers were observed in all dose tertiles. Gains in Kansas City Cardiomyopathy Questionnaire-23 scores were comparable regardless of dose category. Consistent reverse cardiac remodeling in all dose categories occurred; the median absolute left ventricular EF improvement across HF dose groups was 9.3%, 8.7%, and 10.2%, for low, moderate, and high doses, respectively; similar improvements in left atrial and ventricular volumes and E/e' were also observed across dose categories. CONCLUSIONS: Among patients with HFrEF, similar improvement in prognostic biomarkers, health status, and cardiac remodeling were observed across various Sac/Val doses. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183."}