# Dosisrespons van sacubitril/valsartan bij HFrEF

*geplaatst 2022-10-18 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2022.08.737 · https://hartvaat.nl/2022/10/18/dosisrespons-van-sacubitril-valsartan-bij-hfref/*

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.

## English: Dose-Response to Sacubitril/Valsartan in Patients With Heart Failure and Reduced Ejection Fraction.

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.

## Abstract (original, from the publication)

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.

Auteurs: Reza Mohebi, Yuxi Liu, Ileana L Piña, Margaret F Prescott, Javed Butler, G Michael Felker, Jonathan H Ward, Scott D Solomon, James L Januzzi

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2022.08.737. Bijgewerkt 2026-07-03T13:29:07Z. 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.