Posted on November 5, 2021
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Go to http://cme.ahajournals.org to take the quiz. For Sources of Funding Prinaberel and Disclosures, see page 208. https://www.ahajournals.org/journal/circ. switch questionnaire. Results: From July 2018 to June 2019, we randomized 93 individuals with the following Prinaberel characteristics: mean age, 60.710.4 years; median time from myocardial infarction, 3.6 years (interquartile range, 1.2C7.2); mean LV ejection portion, 36.8%7.1%; and median NT-proBNP, 230 pg/mL (interquartile range, 124C404). Sacubitril/valsartan, compared with valsartan, did not significantly reduce LV end-systolic volume index; modified between-group difference, C1.9 mL/m2 (95% CI, C4.9 to 1 1.0); value 0.05 was considered statistically significant. All analyses were carried out using R Studio and R version 4.0.0 (R Foundation for Statistical Computing, Vienna, Austria). Results Recruitment took place between July 2018 and June 2019; follow-up appointments were completed in June 2020. Rabbit Polyclonal to SYT11 Of 158 individuals screened from 7 sites in the National Health Services Greater Glasgow and Clyde Health Table, 93 were randomly assigned (47 to sacubitril/valsartan and 46 to valsartan). Baseline Characteristics The baseline characteristics of individuals summarized by randomized treatment allocation are displayed in Table ?Table1.1. The mean (SD) age was 60.7 (10.4) years, and 85 individuals (91.4%) were male. The median time from MI was 3.6 years (interquartile range, 1.2C7.2). The index MI was an ST-elevation MI in 90 (96.8%) individuals and in the anterior location in 88 (94.6%) individuals, and most individuals (89 [95.7%]) experienced received percutaneous or surgical revascularization as treatment for the MI. A -blocker was taken by 87 (93.5%) individuals, a mineralocorticoid-receptor antagonist by 40 (43%), and a loop diuretic by 11 (11.8%). The mean (SD) cardiac MRI LVEF was 36.8% (7.1%), and median NT-proBNP was 230 pg/mL (interquartile range, 124C404). Table 1. Baseline Characteristics of Randomized Individuals Open in a separate windows Completeness of Follow-Up and Adherence Of the 47 individuals randomized to sacubitril/valsartan, 46 remained on randomized therapy and experienced complete primary end result data at baseline and week 52 (Number II in the Data Supplement). Of the 46 individuals randomly assigned to valsartan, 46 remained on randomized therapy, and 44 experienced total main end result data at baseline and week 52. There was 1 death (sudden cardiac death) in the sacubitril/valsartan group, and no deaths in the valsartan group. Among the living individuals at the end of the trial, 42 of 46 (91.3%) were taking the prospective dose of sacubitril/valsartan (97/103 mg twice daily), and 46 of 46 (100%) were taking the prospective dose of valsartan (160 mg twice daily). Main Outcome LVESVI decreased by 4.06.6 mL/m2 between baseline and 52 Prinaberel weeks in the sacubitril/valsartan group and by 2.07.3 mL/m2 in the valsartan group: adjusted between-group difference, C1.9 (95% CI, C4.9 to 1 1.0) mL/m2; value=0.036). Subgroup analyses of individuals below and at or above the median NT-proBNP level at baseline (230 pg/mL) suggested an effect with sacubitril/valsartan in individuals at or above the median (modified between-group difference, C5.1 mL/m2 [95% CI, C9.2 to C1.0]) but not in those below the median (adjusted between-group difference, 1.3 Prinaberel mL/m2 [95% CI, C2.9 to 5.5]; Number III in the Data Supplement). Table 2. Switch in Main and Secondary Results With Sacubitril/Valsartan or Valsartan From Baseline to Week 52 Open in a separate window Open in a separate window Number 1. Switch in LVESVI from baseline to week 52. Data offered as mean and error bars represent 95% CIs. *Calculated using a linear regression model modified for randomized treatment, baseline value of the outcome, use of diuretics at baseline, and time from randomization to cardiac magnetic resonance imaging. LVESVI shows remaining ventricular end-systolic volume index. Secondary Results NT-proBNP and Troponin There were no significant between-group variations after 52 weeks of treatment with sacubitril/valsartan or valsartan in either NT-proBNP or high-sensitivity cardiac troponin I (Table ?(Table22). Cardiac MRI LVEDVI (between-group difference, C3.1 mL/m2 [95% CI, C6.8, 0.6]), remaining atrial volume index (C2.3 mL/m2 [95% CI, C6.6, 2.0]), and LV mass index (C1.5 g/m2 [95% CI, C3.5, 0.6]) all decreased to a greater degree with sacubitril/valsartan compared with valsartan; however, none of the between-group variations were statistically significant (all value 0.003 ( em P /em =0.05/15). Conclusions In individuals with asymptomatic LVSD late after MI, the addition of a neprilysin inhibitor to standard.