# Sacubitril/valsartan bij HFmrEF/HFpEF met verslechterend hartfalen

*geplaatst 2023-07-04 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2023.04.019 · https://hartvaat.nl/2023/07/04/sacubitril-valsartan-bij-hfmref-hfpef-met-verslechterend-hartfalen/*

Analyse toonde dat sacubitril/valsartan bij patiënten met HFmrEF/HFpEF en verslechterend hartfalen (recente hospitalisatie of verhoogd NT-proBNP) een groter voordeel biedt dan bij stabiele patiënten. De ziekte-ernst identificeert wie het meest profiteert.

## English: Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure.

This analysis showed that sacubitril-valsartan benefits patients with HFmrEF/HFpEF and worsening heart failure (recent hospitalization or elevated natriuretic peptides), supporting ARNI use in the higher-risk phenotype within this population.

## Abstract (original, from the publication)

BACKGROUND: U.S. guidelines recommend consideration of sacubitril/valsartan in chronic heart failure (HF) and mildly reduced or preserved ejection fraction (EF). Whether initiation is safe and effective in EF >40% after a worsening heart failure (WHF) event is unknown. OBJECTIVES: PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF) assessed sacubitril/valsartan vs valsartan in EF >40% following a recent WHF event. METHODS: PARAGLIDE-HF is a double-blind, randomized controlled trial of sacubitril/valsartan vs valsartan in patients with EF >40% enrolled within 30 days of a WHF event. The primary endpoint was time-averaged proportional change in amino terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline through Weeks 4 and 8. A secondary hierarchical outcome (win ratio) consisted of: 1) cardiovascular death; 2) HF hospitalizations; 3) urgent HF visits; and 4) change in NT-proBNP. RESULTS: In 466 patients (233 sacubitril/valsartan; 233 valsartan), time-averaged reduction in the NT-proBNP was greater with sacubitril/valsartan (ratio of change: 0.85; 95% CI: 0.73-0.999; P = 0.049). The hierarchical outcome favored sacubitril/valsartan but was not significant (unmatched win ratio: 1.19; 95% CI: 0.93-1.52; P = 0.16). Sacubitril/valsartan reduced worsening renal function (OR: 0.61; 95% CI: 0.40-0.93) but increased symptomatic hypotension (OR: 1.73; 95% CI: 1.09-2.76). There was evidence of a larger treatment effect in the subgroup with EF ≤60% for NT-proBNP change (0.78; 95% CI: 0.61-0.98) and the hierarchical outcome (win ratio: 1.46; 95% CI: 1.09-1.95). CONCLUSIONS: Among patients with EF >40% stabilized after WHF, sacubitril/valsartan led to greater reduction in plasma NT-proBNP levels and was associated with clinical benefit compared with valsartan alone, despite more symptomatic hypotension. (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF; NCT03988634).

Auteurs: Robert J Mentz, Jonathan H Ward, Adrian F Hernandez, Serge Lepage, David A Morrow, Samiha Sarwat, Kavita Sharma, Randall C Starling, Eric J Velazquez, Kristin M Williamson, Akshay S Desai, Shelley Zieroth, Scott D Solomon, Eugene Braunwald

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2023.04.019. Bijgewerkt 2026-07-03T18:39:04Z. 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.