Docherty, K. F. et al. (2023) Efficacy of omecamtiv mecarbil in heart failure with reduced ejection fraction according to N‐terminal pro‐B ‐type natriuretic peptide level: insights from the GALACTIC‐HF trial. European Journal of Heart Failure, 25(2), pp. 248-259. (doi: 10.1002/ejhf.2763) (PMID:36597719)
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Abstract
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is predictive of both outcomes and response to treatment in patients with heart failure with reduced ejection fraction (HFrEF). Objective: To examine the effect of the cardiac myosin activator omecamtiv mecarbil according to baseline NT-proBNP level in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure trial (GALACTIC-HF). Methods: The primary outcome was the composite of a worsening HF event (urgent clinic visit, emergency department visit, or hospitalization) or cardiovascular death. We prespecified analysis of the effect of treatment according to baseline NT-proBNP (≤median, >median), excluding individuals with AF/AFL. Results: Of the 8232 patients analyzed, 8206 had an available baseline NT-proBNP measurement. Among the 5971 patients not in AF/AFL, the median (Q1, Q3) NT-proBNP level was 1675 (812–3579) pg/ml. Hazard ratios (HR) for the effect of omecamtiv mecarbil, compared with placebo, for the primary endpoint in patients without AF/AFL were: ≤median 0.94 (95% CI, 0.80–1.09), >median 0.81 (0.73–0.90) [P-interaction = 0.095]; for the overall population (including patients with AF/AFL) the HRs were ≤ median 1.01 (0.90–1.15) and > median 0.88 (0.80–0.96) [P-interaction = 0.035]. There was an interaction between treatment and NT-proBNP, examined as a continuous variable, with greater effect of omecamtiv mecarbil on the primary outcome in patients with a higher baseline NT-proBNP (P-interaction = 0.086). Conclusions: In GALACTIC-HF, the benefit of omecamtiv mecarbil appeared to be larger in patients with higher baseline NT-proBNP levels, especially in patients without AF/AFL.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Cleland, Professor John and Docherty, Dr Kieran and McMurray, Professor John |
| Authors: | Docherty, K. F., McMurray, J. J.V., Claggett, B. L., Miao, Z. M., Adams, K. F., Arias‐Mendoza, A., Cleland, J. G.F., Diaz, R., Echeverría Correa, L. E., Felker, G. M., Fonseca, C., Li, J., Metra, M., Sliwa‐Hahnle, K., Solomon, S. D., Vandekerckhove, H. J., Vinereanu, D., Voors, A. A., Heitner, S. B., Kupfer, S., Malik, F. I., Meng, L., and Teerlink, J. R. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | Wiley |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
| Published Online: | 04 January 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in European Journal of Heart Failure 25(2): 248-259 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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