hs-TnT helps identify patients of HFpEF likely to benefit from sacubitril/valsartan: Study

Heart failure (HF) is a condition that causes ventricular dysfunction. Left ventricular failure is characterized by shortness of breath and fatigue. And the right ventricular failure is characterized by peripheral and abdominal fluid accumulation; the ventricles can be involved together or separately.

While, heart failure with preserved ejection fraction (HFpEF) occurs when the left ventricle is unable to function efficiently during the diastolic phase, which causes the amount of blood pumped out to the body to be less than normal. It is also called diastolic heart failure.

A common marker of myocardial injury in Heart Failure is high-sensitivity troponin-T (hs-TnT). The term myocardial injury applies to any patient in whom at least one cardiac troponin (cTn) concentration is above the 99th percentile upper reference limit (URL).

A study was conducted by a group of researchers from Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy, wherein they investigated the association among high-sensitivity troponin-T (hs-TnT), outcomes, and treatment with sacubitril/valsartan in patients with heart failure (HF) and preserved ejection fraction (HFpEF).

The researchers conducted a PRAGON-HF trial, which included 4,796 patients with HFpEF, who were divided randomly into two groups; either receiving sacubitril/valsartan or valsartan. They later compared the risk of the composite outcome of cardiovascular death and total Heart Failure hospitalization according to hs-TnT. Lastly, they also evaluated the effect of allocated treatment on hs-TnT.

The results of the study are as follows:

· In 1,141 patients (24%) hs-TnT was available at run-in (median value: 17 ng/L) and 1,260 (26%) at randomization. Out of which 58.3% had hs-TnT greater than14 ng/L, which is the upper limit of normal.

· There were a total of 393 outcome events during a median follow-up of 34 months.

· hs-TnT at randomization was an independent predictor of the composite outcome after adjusting other variables.

· Compared with valsartan, sacubitril/valsartan significantly reduced hs-TnT by 9% at week 16.

· Patients whose hs-TnT decreased from randomization to 16 weeks to at or below the median value of 17 ng/L subsequently had a lower risk of Cardiovascular death/Hospitalization for Heart Failure compared with those with persistently elevated hs-TnT.

· Patients with higher baseline hs-TnT (>17 ng/L) appeared to have a greater benefit from sacubitril/valsartan treatment when accounting for other potential effect modifiers.

The researchers concluded that Higher baseline hs-TnT was linked with increased vulnerability to Cardiovascular death/Hospitalization for Heart Failure whereas hs-TnT decrease at 16 weeks reduced both the risks substantially. Also, treatment with Sacubitril/valsartan significantly reduced hs-TnT compared with just valsartan. Lastly, hs-TnT may help identify patients with HFpEF who are more likely to benefit from sacubitril/valsartan.

Reference:

Integrating High-Sensitivity Troponin T and Sacubitril/Valsartan Treatment in HFpEF: The PARAGON-HF Trial by Gori M et. al published in the JAAC: Heart Failure.

DOI: 10.1016/j.jchf.2021.04.009