Electrocardiographic predictors of response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction.
J Electrocardiol
; 84: 104-108, 2024.
Article
en En
| MEDLINE
| ID: mdl-38615617
ABSTRACT
BACKGROUND:
Sacubitril/valsartan (SV) is currently recommended as a first-line therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to its significant clinical and prognostic benefit; however, not all patients respond to therapy and predictors of clinical response to SV remain under-studied.AIMS:
To identify electrocardiographic (ECG) predictors of response to SV therapy in HFrEF patients.METHODS:
A retrospective analysis of a hospital heart failure registry was undertaken. Consecutive HFrEF patients (New York Heart Association class II-III) on maximal-dose SV were studied. Response to SV was defined as ≥10% relative improvement in left ventricular ejection fraction (LVEF) at 3-months post-maximal-dose therapy. Pre-therapy ECGs were retrospectively analyzed for axes and standard wave and interval durations. Logistic regression was used to estimate odds ratios and 95% confidence intervals for associations between predictors and therapeutic response. Backward stepwise regression was employed to develop a parsimonious model.RESULTS:
P-wave duration (PWD) 100-120 ms, PWD >120 ms, and QTc >460 ms were associated with response to SV on univariateanalysis:
OR 18.00 (4.45-122.90), 5.00 (1.47-20.42), and 3.10 (1.18-9.22), respectively. The preferred model that included the former two predictors in combination with pre-therapy creatinine, mineralocorticoid receptor antagonist use, and LVEF was highly selective (area under the ROC curve = 0.868).CONCLUSIONS:
Prolongation of both PWD and QTc interval on baseline ECG in HFrEF patients is predictive of therapeutic response to maximal-dose SV therapy and may indicate early cardiac remodeling that is highly amenable to reversal.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
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Compuestos de Bifenilo
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Combinación de Medicamentos
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Electrocardiografía
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Valsartán
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Aminobutiratos
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Insuficiencia Cardíaca
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Electrocardiol
Año:
2024
Tipo del documento:
Article
País de afiliación:
Irlanda