Rationale and methods of a randomized trial evaluating the effect of neprilysin inhibition on left ventricular remodelling
| Autor: | Pardeep S. Jhund, Giles Roditi, John J.V. McMurray, Paul Forsyth, Rosemary L. Godeseth, Paul Welsh, Katriona Brooksbank, Mark C. Petrie, Ross T. Campbell, Kieran F. Docherty, Bethany Stanley, Alex McConnachie |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Ramipril
lcsh:Diseases of the circulatory (Cardiovascular) system Angiotensin receptor medicine.medical_specialty Heart failure 030204 cardiovascular system & hematology Sacubitril 03 medical and health sciences Angiotensin Receptor Antagonists 0302 clinical medicine Internal medicine Original Research Articles medicine Clinical endpoint Humans 030212 general & internal medicine Myocardial infarction Original Research Article Natriuretic peptides Renin angiotensin aldosterone system Ejection fraction Ventricular Remodeling business.industry Stroke Volume medicine.disease Clinical trial Valsartan lcsh:RC666-701 Cardiology Neprilysin Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | ESC Heart Failure ESC Heart Failure, Vol 8, Iss 1, Pp 129-138 (2021) |
| ISSN: | 2055-5822 |
| Popis: | Aims: \ud In patients at high risk of heart failure following myocardial infarction (MI) as a result of residual left ventricular systolic dysfunction (LVSD), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan may result in a greater attenuation of adverse left ventricular (LV) remodelling than renin angiotensin aldosterone system inhibition alone, due to increased levels of substrates for neprilysin with vasodilatory, anti‐hypertrophic, anti‐fibrotic, and sympatholytic effects.\ud \ud Methods: \ud We designed a randomized, double‐blinded, active‐comparator trial to examine the effect of sacubitril/valsartan to the current standard of care in reducing adverse LV remodelling in patients with asymptomatic LVSD following MI. Eligible patients were ≥3 months following MI, had an LV ejection fraction ≤40% as measured by echocardiography, were New York Heart Association functional classification I, tolerant of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker at equivalent dose of ramipril 2.5 mg twice daily or greater, and taking a beta‐blocker unless contraindicated or intolerant. Patients were randomized to sacubitril/valsartan (target dose 97/103 mg twice daily) or valsartan (target dose 160 mg twice daily). The primary endpoint will be change in LV end‐systolic volume indexed for body surface area measured using cardiac magnetic resonance imaging over 52 weeks from randomization. Secondary endpoints include other magnetic resonance imaging‐based metrics of LV remodelling, biomarkers associated with LV remodelling and neurohumoral activation, and change in patient well‐being assessed using a patient global assessment questionnaire.\ud \ud Conclusions: \ud This trial will investigate the effect of neprilysin inhibition on LV remodelling and the neurohumoral actions of sacubitril/valsartan in patients with asymptomatic LVSD following MI. |
| Databáze: | OpenAIRE |
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