Troponins May Be Useful Guide For ARNI Therapy HFpEF, Finds
The authors examined the relationship 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 PARAGON-HF trial randomized 4,796 patients with HFpEF to sacubitril/valsartan or valsartan. They compared the risk of the composite outcome of cardiovascular death (CVD) and total HF hospitalization (HHF) according to hs-TnT. We also assessed the effect of allocated treatment on hs-TnT.

-- hs-TnT was available in 1,141 patients (24%) at run-in (median value: 17 ng/L) and 1,260 (26%) at randomization, with 58.3% having hs-TnT more than 14 ng/L (upper limit of normal).

-- During a median follow-up of 34 months, there were 393 outcome events (82 CVD, 311 HHF).

-- Adjusting for demographics, comorbidities, left ventricular ejection fraction (LVEF), and N-terminal pro b-type natriuretic peptide (NT-proBNP), log-hs-TnT at randomization was an independent predictor of the composite outcome.

-- 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 CVD/HHF compared with those with persistently elevated hs-TnT.

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

Conclusively, higher baseline hs-TnT was associated with increased risk of CVD/HHF, whereas hs-TnT decrease at 16 weeks led to lower subsequent risk of CVD/HHF compared with those who had persistently elevated values. Sacubitril/valsartan significantly reduced hs-TnT compared with valsartan. hs-TnT may be helpful in identifying patients with HFpEF who are more likely to benefit from sacubitril/valsartan.