Troponin‐I levels as a potential prognostic biomarker of sacubitril/valsartan treatment response in heart failure with reduced ejection fraction: Who will benefit most?

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 41; no. 12; pp. 1548 - 1554
• Main Authors: Nakou, Eleni S., Marketou, Maria E., Chlouverakis, Gregory I., Patrianakos, Alexandros P., Vardas, Panos E., Parthenakis, Fragiskos I.
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.12.2018; John Wiley & Sons, Inc
• Subjects: Aged; Aminobutyrates - therapeutic use; Biomarkers - blood; cardiopulmonary exercise; Clinical Investigations; Drug Combinations; Echocardiography; Ejection fraction; Exercise Test; Female; Follow-Up Studies; Heart failure; Heart Failure - blood; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; predictive biomarkers; Prognosis; Prospective Studies; sacubitril/valsartan; Stroke Volume - physiology; Tetrazoles - therapeutic use; Troponin I - blood; Ventricular Function, Left - physiology; heart failure; predictive biomarkers; cardiopulmonary exercise; sacubitril/valsartan
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23099

Background Despite robust data on the benefits of sacubitril/valsartan (LCZ696) in patients with chronic heart failure with reduced ejection fraction (HFrEF), there is no evidence yet on prespecified predictive markers of its efficacy. Hypothesis The objective of this study was to identify potential prognostic factors of LCZ696 treatment response. Methods We included 48 symptomatic patients with chronic HFrEF (left ventricular ejection fraction ≤35%) and New York Heart Association (NYHA) class II/III: Group A (N = 23) received LCZ696 (105 ± 30 mg twice daily), whereas it was not prescribed in group B (N = 25) according to physician's judgment. Analysis of biochemical parameters, cardiopulmonary exercise testing, and echocardiographic evaluation was performed at baseline and 6 months later. Results The baseline serum troponin‐I levels (TnI) and peak oxygen uptake (VO2max) were positively associated with the increase in VO2max (ΔVO2max = +14.11%, P < 0.05 vs group B) after sacubitril/valsartan treatment (r = 0.68, P = 0.001 and r = 0.57, P = 0.004, respectively). Positive correlations were reported between ΔVO2max and the improvements in the ratio of early diastolic filling to myocardial tissue velocity (ΔE/E′) and the tricuspid annular peak systolic velocity (ΔSa) in group A (r = 0.58, P = 0.004 and r = 0.60, P = 0.002, respectively). In multiple regression analysis, ΔVO2max was correlated significantly with TnI (beta = 0.35, P = 0.048), ΔE/E′ (beta = 0.36, P = 0.031) and ΔSa (beta = 0.37, P = 0.035). Conclusions TnI levels may be an independent predictive marker of sacubitril/valsartan efficacy in HFrEF.