Background
Among patients with heart failure with reduced ejection fraction (HFrEF, left ventricular
[LV] EF ≤ 40%), female sex is associated with differences compared to men.
Objectives
To determine sex-based differences in biomarkers, self-reported health status, and
magnitude of longitudinal changes in measures of reverse cardiac remodeling among
HFrEF patients treated with sacubitril/valsartan (S/V).
Methods
This was a planned subgroup analysis of patients initiated on S/V in the Prospective
Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto
Therapy for Heart Failure (PROVE-HF) Study.
Results
There were 226 (28.5%) women in the study. Though women had lower baseline N-terminal
pro B-type natriuretic peptide (NT-proBNP), they had more rapid early reduction in
the biomarker after initiation of S/V. Compared to men, women had lower average baseline
Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 Total Symptom Score (67.6 vs 71.9;
P =.003) but showed greater linear improvement (7.4 vs. 5.5 points; P <0.001) and
faster pace of KCCQ change (-1.39 vs -1.09; P <0.001) over the course of the trial.
Women had higher LVEF than men at baseline, however following S/V initiation, women
reverse remodeled earlier than men, with more consistent change than in men. Reduction
in NT-proBNP was associated with reverse cardiac remodeling in both women and men.
Treatment with S/V was well tolerated in all.
Conclusions
In women with HFrEF, treatment with S/V was well-tolerated, and associated with unique
differences in NT-proBNP change, reverse cardiac remodeling and change in KCCQ-23
score compared to men (PROVE-HF; NCT02887183).
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Article info
Identification
Copyright
© 2020 Published by Elsevier Inc.
