Publications by authors named "Kristin M Williamson"
Aims: Whether prior treatment with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) modifies efficacy and safety of sacubitril/valsartan (Sac/Val) in patients with heart failure (HF) and ejection fraction (EF) >40% is unclear, thus Sac/Val according to ACEi/ARB status at baseline was assessed.
Methods And Results: This was a pre-specified analysis of Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF (PARAGLIDE-HF), a double-blind, randomized controlled trial of Sac/Val versus valsartan, categorizing patients according to baseline ACEi/ARB status. The primary endpoint was time-averaged proportional change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline through weeks 4 and 8.
Background: The win ratio (WR) is an emerging alternative for reporting composite outcomes, prioritizing clinically significant events such as mortality while incorporating surrogate measures. However, its benefits should be weighed against limitations, particularly the influence of lower hierarchical outcomes. This secondary analysis of the PARAGLIDE-HF trial performed a WR sensitivity analysis using a modified hierarchical composite outcome to assess the utility of WR sensitivity analysis and the efficacy of sacubitril/valsartan versus valsartan.
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- * A total of 114 HF patients participated in the GDMT clinic, showing a remarkable increase in the use of recommended 4-drug therapy—from 21% to 88%—along with higher medication dosages compared to usual care.
- * Results indicated significant improvements in HF symptoms and heart function metrics, with 94% of patients in the GDMT clinic experiencing symptomatic relief after a median treatment length of about 16 weeks.
Article Synopsis
- - The PARAGLIDE-HF study examined patients with decompensated heart failure, comparing the effects of sacubitril/valsartan to valsartan on NT-proBNP levels and clinical outcomes.
- - Among the 466 participants, 33% had de novo heart failure while 67% had chronic heart failure, with no significant differences in NT-proBNP reduction between the two groups after treatment.
- - The findings suggest that sacubitril/valsartan benefits both de novo and chronic heart failure patients, but there is no significant interaction between the type of heart failure and the medication's effectiveness.
Article Synopsis
- In the PARAGLIDE-HF trial, sacubitril/valsartan showed better results than valsartan alone in reducing NT-proBNP levels in patients with ejection fraction over 40% after heart failure, but increased instances of symptomatic hypotension (SH) were noted.
- Of the 466 patients studied, 19.7% experienced SH, with a higher occurrence in those treated with sacubitril/valsartan compared to valsartan, though the timing of SH events was similar in both groups.
- Patients with SH were more likely to be white, have lower baseline systolic blood pressure, and have a higher left ventricular ejection fraction, but the drug's effectiveness in lowering NT-proBNP
Background: The efficacy and safety of sacubitril/valsartan in patients hospitalized with heart failure (HF) across the spectrum of left ventricular ejection fraction (EF) has not been described.
Objectives: Data from randomized trials of sacubitril/valsartan in HF patients with EF ≤40% (PIONEER-HF [Comparison of Sacubitril/Valsartan Versus Enalapril on Effect of NT-proBNP in Patients Stabilized From an Acute Heart Failure Episode] trial) and >40% (PARAGLIDE-HF [Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF] trial) following recent worsening heart failure (WHF) were pooled to examine treatment effect across the EF spectrum.
Methods: The PIONEER-HF and PARAGLIDE-HF trials were double-blind, randomized trials of sacubitril/valsartan vs control therapy (enalapril or valsartan, respectively).
Objectives: To assess tissue Doppler-derived mitral annular isovolumic contraction velocity (ICV) after starting sacubitril/valsartan (sac/val) for the treatment of heart failure with reduced ejection fraction (HFrEF) and left ventricular [LV] EF < 40%).
Background: ICV may inform load-independent systolic function; combining ICV and LVEF may improve assessment of LV contractility.
Methods: Among 651 participants with HFrEF treated with sac/val, echocardiograms were performed at baseline, 6 and 12 months.
Article Synopsis
- U.S. guidelines suggest considering sacubitril/valsartan for chronic heart failure patients with a mildly reduced or preserved ejection fraction (EF), but its safety and effectiveness after a worsening heart failure event in patients with EF >40% was unclear.
- The PARAGLIDE-HF trial compared sacubitril/valsartan to valsartan in patients with EF >40% who were enrolled within 30 days post-worsening heart failure, measuring the change in NT-proBNP levels as the primary endpoint.
- Results showed that sacubitril/valsartan significantly reduced NT-proBNP levels and had some clinical benefits, although it increased cases of symptomatic hypotension; a greater treatment effect was observed in
Aims: The PARAGLIDE-HF trial demonstrated reductions in natriuretic peptides with sacubitril/valsartan compared with valsartan in patients with heart failure (HF) with mildly reduced or preserved ejection fraction who had a recent worsening HF event, but was not adequately powered to examine clinical outcomes. PARAGON-HF included a subset of PARAGLIDE-HF-like patients who were recently hospitalized for HF. Participant-level data from PARAGLIDE-HF and PARAGON-HF were pooled to better estimate the efficacy and safety of sacubitril/valsartan in reducing cardiovascular and renal events in HF with mildly reduced or preserved ejection fraction.
View Article and Find Full Text PDFBackground: Several different B-type natriuretic peptide (BNP) assays are used clinically for diagnostic and prognostic evaluation of heart failure (HF). BNP binds weakly to neprilysin and is cleaved in multiple areas adjacent to the binding sites for the antibodies used in these immunoassays. We assessed the changes in BNP following neprilysin inhibition as measured by 3 immunoassays that recognize different epitopes.
View Article and Find Full Text PDFBackground: Sacubitril/valsartan (S/V) treatment is associated with reverse cardiac remodeling and reductions in biomarkers reflecting ventricular wall stress and myocardial injury, such as NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-cTnT (high-sensitivity cardiac troponin T), and soluble suppressor of tumorigenicity 2 (sST2). How longitudinal changes in these biomarkers analyzed collectively are associated with cardiac remodeling in patients with heart failure with reduced ejection fraction treated with S/V is uncertain.
Methods: In a prospective study of S/V in patients with heart failure with reduced ejection fraction, this prespecified exploratory analysis included patients with serially collected biomarkers and echocardiographic measures of cardiac remodeling through 12 months of treatment.
Background: Treatment of heart failure with reduced ejection fraction (EF) may improve patient-reported health outcomes.
Objectives: The purpose of this study was to determine timing and magnitude of change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-23 scores following initiation of sacubitril/valsartan and interaction with change in amino-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations.
Methods: From a single-arm, open-label study of patients initiated on sacubitril/valsartan, KCCQ-23 scores and NT-proBNP were obtained at baseline and follow-up through 12 months.
Association of Change in N-Terminal Pro-B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction.
JAMA
September 2019
Importance: In patients with heart failure and reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan reduces N-terminal pro-b-type natriuretic peptide (NT-proBNP) concentrations. The effect of sacubitril-valsartan on cardiac remodeling is uncertain.
Objective: To determine whether NT-proBNP changes in patients with HFrEF treated with sacubitril-valsartan correlate with changes in measures of cardiac volume and function.