Myocardial work predicts MACE in HFrEF patients on sacubitril/valsartan
Sacubitril/valsartan induces significant improvements in myocardial constructive work (CW) and myocardial work efficiency (WE) in patients with heart failure with reduced ejection fraction (HFrEF) who receive comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy. In these patients, CW is shown to predict major adverse cardiac events (MACEs).
Among 79 patients with HFrEF treated with sacubitril/valsartan who underwent echocardiography at baseline and after 6 months and 12 months of treatment, significant increases were seen in global myocardial CW and myocardial WE (p<0.0001 for both). [Galli E, et al, ESC 2020]
During 2.6 years of follow-up, CW was the only predictor of MACEs (hazard ratio [HR], 0.99; 95 percent confidence interval [CI], 0.99 to 1.00; p=0.04) after correction for left ventricular (LV) size, LVEF and WE. A myocardial CW of <910 mm Hg identified patients at particularly high risk of MACEs (HR, 11.09; 95 percent CI, 1.45 to 98.94; p=0.002).
“Estimation of CW before initiation of sacubitril/valsartan therapy allows the prediction of MACEs,” the investigators concluded.