# Langetermijneffecten van sacubitril/valsartan bij HFrEF: Italiaanse real-world studie

*geplaatst 2026-03-17 · Hartfalen · ESC heart failure · doi 10.1093/eschf/xvag082 · https://hartvaat.nl/2026/03/17/langetermijneffecten-van-sacubitril-valsartan-bij-hfref-italiaanse-real-world-st/*

De langetermijneffecten van sacubitril/valsartan (S/V) in de praktijk en de impact van dosisverlaging of staken zijn minder goed gedefinieerd. In deze multicenter retrospectieve studie (592 poliklinische HFrEF-patiënten, gemiddelde LVEF 32%) verbeterden na de start van S/V het NT-proBNP, de kwaliteit van leven (KCCQ), de LVEF en de globale longitudinale strain significant en aanhoudend. Tijdens een mediane follow-up van 3,7 jaar kreeg 38% een majeur cardiovasculair event (MACE). Staken van S/V (HR 1,52) en een ongunstige verandering in GLS of KCCQ waren onafhankelijk geassocieerd met MACE; dosisverlaging en staken identificeerden patiënten met een hoger risico. S/V gaf dus blijvende verbetering van remodellering en kwaliteit van leven, terwijl staken of dosisverlaging een risicosignaal vormt.

## English: Long-term outcomes following Sacubitril/Valsartan therapy for chronic HFrEF. Italian Real-World Multicenter Study

The long-term real-world effects of sacubitril/valsartan (S/V) and the impact of dose reduction or discontinuation are less well defined. In this multicentre retrospective study (592 outpatient HFrEF patients, mean LVEF 32%), after S/V initiation NT-proBNP, quality of life (KCCQ), LVEF and global longitudinal strain improved significantly and durably. Over a median follow-up of 3.7 years, 38% had a major adverse cardiovascular event (MACE). S/V discontinuation (HR 1.52) and adverse change in GLS or KCCQ were independently associated with MACE; dose reduction and discontinuation identified higher-risk patients. S/V thus produced sustained improvement in remodelling and quality of life, while stopping or dose-reducing was a risk signal.

## Abstract (original, from the publication)

BACKGROUND AND AIMS: Long-term real-world effects of sacubitril/valsartan (S/V) and the impact of S/V dose reduction or discontinuation are less defined. We assessed longitudinal changes after S/V initiation and the association of dose changes with major adverse cardiovascular events (MACE). METHODS: Multicenter retrospective study of 592 HFrEF outpatients starting S/V (83% men; age 68±10 years; LVEF 32±7%). NT-proBNP, Kansas City Cardiomyopathy Questionnaire (KCCQ) and echocardiography were collected at baseline, 12 months and last follow-up. MACE was analyzed with Kaplan-Meier and Cox models. RESULTS: NT-proBNP decreased from 1,000 (494-2,333) to 751 (304-1,726) and 735 (215-1,980) pg/mL (p<0.001). KCCQ improved from 53±15 to 62±14 and 66±15 (p<0.001). LVEF increased from 32±7 to 36±8 and 37±9% (p<0.001) and GLS improved from -10.8±3.2 to -12.3±3.1 and -14.0±2.9% (p<0.001). During a median follow-up of 3.72 years, 225 patients (38%) experienced MACE (36 deaths; 134 HF hospitalizations). MACE incidence was higher in patients with S/V discontinuation and with dose reduction (log-rank p=0.013 and p=0.014). In multivariable Cox analysis, S/V discontinuation (HR 1.52, 95% CI 1.28-1.97; p=0.040), change in GLS (HR 0.81, 95% CI 0.67-0.98; p=0.028) and change in KCCQ (HR 0.95, 95% CI 0.92-0.98; p=0.001) were independently associated with MACE. CONCLUSIONS: S/V initiation was associated with sustained improvements in NT-proBNP, quality of life and cardiac remodeling. S/V discontinuation or dose reduction identified patients at higher MACE risk.

Auteurs: Giuseppe Dattilo, Roberto Licordari, Egidio Imbalzano, Antonio Cannata, Piergiuseppe Agostoni, Alberto Aimo, Francesca Barillà, Erberto Carluccio, Michele Ciccarelli, Gianluca Di Bella, Frank L Dini, Michele Emdin, Francesco Loria, Massimo Mapelli, Enrica Mariano, Francesco Paolo Niglio, Alberto Palazzuoli, Gianpaolo Palmieri, Simona Pavoncelli, Elisabetta Salvioni, Gianluigi Savarese, Michele Correale

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Bron: ESC heart failure, https://doi.org/10.1093/eschf/xvag082. Bijgewerkt 2026-07-03T18:39:21Z. 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.