Cardiovascular-kidney-metabolic overlap in heart failure with preserved ejection fraction: Cardiac structure and function, clinical outcomes, and response to sacubitril/valsartan in PARAGON-HF
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Cardiovascular-kidney-metabolic overlap in heart failure with preserved ejection fraction : Cardiac structure and function, clinical outcomes, and response to sacubitril/valsartan in PARAGON-HF. / Lassen, Mats C.H.; Ostrominski, John W.; Claggett, Brian L.; Packer, Milton; Zile, Michael; Desai, Akshay S.; Shah, Amil M.; Cikes, Maja; Merkely, Bela; Gori, Mauro; Wang, Xiaowen; Hegde, Sheila M.; Pfeffer, Marc A.; Lefkowitz, Martin; McMurray, John J.V.; Solomon, Scott D.; Vaduganathan, Muthiah.
I: European Journal of Heart Failure, 2024.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Cardiovascular-kidney-metabolic overlap in heart failure with preserved ejection fraction
T2 - Cardiac structure and function, clinical outcomes, and response to sacubitril/valsartan in PARAGON-HF
AU - Lassen, Mats C.H.
AU - Ostrominski, John W.
AU - Claggett, Brian L.
AU - Packer, Milton
AU - Zile, Michael
AU - Desai, Akshay S.
AU - Shah, Amil M.
AU - Cikes, Maja
AU - Merkely, Bela
AU - Gori, Mauro
AU - Wang, Xiaowen
AU - Hegde, Sheila M.
AU - Pfeffer, Marc A.
AU - Lefkowitz, Martin
AU - McMurray, John J.V.
AU - Solomon, Scott D.
AU - Vaduganathan, Muthiah
N1 - Publisher Copyright: © 2024 European Society of Cardiology.
PY - 2024
Y1 - 2024
N2 - Aims: Cardiovascular-kidney-metabolic (CKM) multimorbidity is prevalent among individuals with heart failure (HF), but whether cardiac structure and function, clinical outcomes, and treatment response to sacubitril/valsartan vary in relation to CKM status is unknown. Methods and results: In this PARAGON-HF post-hoc analysis, we evaluated the impact of CKM multimorbidity (atherosclerotic cardiovascular [CV] disease, chronic kidney disease, and type 2 diabetes) on cardiac structure and function, clinical outcomes, and treatment effects of sacubitril/valsartan versus valsartan. The primary outcome was a composite of total HF hospitalizations and CV death. Secondary outcomes included the individual components of the primary outcome and a composite kidney outcome (sustained estimated glomerular filtration rate reduction of ≥50%, end-stage kidney disease, or kidney-related death). At baseline, 35.2% had one CKM condition, 33.3% had two, 15.9% had three, and only 15.6% had HF alone. CKM multimorbidity was associated with higher septal and posterior wall thickness, lower global longitudinal strain, higher E/e', and worse right ventricular function. Total HF hospitalizations or CV death increased with greater CKM multimorbidity, with the highest relative risk observed with three CKM conditions (rate ratio 3.06, 95% confidence interval 2.33–4.03), compared with HF alone. Treatment effects of sacubitril/valsartan were consistent irrespective of the number of CKM conditions for the primary endpoint (pinteraction = 0.75), CV death (pinteraction = 0.82), total HF hospitalizations (pinteraction = 0.67), and the composite kidney endpoint (pinteraction = 0.99). Conclusions: Cardiovascular-kidney-metabolic multimorbidity was common in PARAGON-HF and associated with adverse changes in cardiac structure and function and with a stepwise increase in risk of clinical outcomes. Treatment effects of sacubitril/valsartan were consistent irrespective of CKM burden. Clinical Trial Registration: ClinicalTrials.gov NCT01920711.
AB - Aims: Cardiovascular-kidney-metabolic (CKM) multimorbidity is prevalent among individuals with heart failure (HF), but whether cardiac structure and function, clinical outcomes, and treatment response to sacubitril/valsartan vary in relation to CKM status is unknown. Methods and results: In this PARAGON-HF post-hoc analysis, we evaluated the impact of CKM multimorbidity (atherosclerotic cardiovascular [CV] disease, chronic kidney disease, and type 2 diabetes) on cardiac structure and function, clinical outcomes, and treatment effects of sacubitril/valsartan versus valsartan. The primary outcome was a composite of total HF hospitalizations and CV death. Secondary outcomes included the individual components of the primary outcome and a composite kidney outcome (sustained estimated glomerular filtration rate reduction of ≥50%, end-stage kidney disease, or kidney-related death). At baseline, 35.2% had one CKM condition, 33.3% had two, 15.9% had three, and only 15.6% had HF alone. CKM multimorbidity was associated with higher septal and posterior wall thickness, lower global longitudinal strain, higher E/e', and worse right ventricular function. Total HF hospitalizations or CV death increased with greater CKM multimorbidity, with the highest relative risk observed with three CKM conditions (rate ratio 3.06, 95% confidence interval 2.33–4.03), compared with HF alone. Treatment effects of sacubitril/valsartan were consistent irrespective of the number of CKM conditions for the primary endpoint (pinteraction = 0.75), CV death (pinteraction = 0.82), total HF hospitalizations (pinteraction = 0.67), and the composite kidney endpoint (pinteraction = 0.99). Conclusions: Cardiovascular-kidney-metabolic multimorbidity was common in PARAGON-HF and associated with adverse changes in cardiac structure and function and with a stepwise increase in risk of clinical outcomes. Treatment effects of sacubitril/valsartan were consistent irrespective of CKM burden. Clinical Trial Registration: ClinicalTrials.gov NCT01920711.
KW - Cardiovascular-kidney-metabolic
KW - Heart failure
KW - Multimorbidity
KW - Sacubitril/valsartan
UR - http://www.scopus.com/inward/record.url?scp=85197157488&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3304
DO - 10.1002/ejhf.3304
M3 - Journal article
C2 - 38932589
AN - SCOPUS:85197157488
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1567-4215
ER -
ID: 398360951