One-half of all heart failure (HF) instances have preserved ejection fraction (HFpEF), and research for successful treatment options has been continuing for many years. However, the predictive usefulness of high sensitivity troponin-T (hs-TnT) in HFpEF is unknown, as is whether hs-Tn changes the sacubitril/valsartan treatment response.
In the PARAGON-HF trial, 4,796 patients with HFpEF were randomly assigned to receive sacubitril/valsartan or valsartan. This study assessed the risk of the composite outcome of CVD and total heart failure (HF) hospitalizations according to hs-TnT and explored the efficacy of this marker among patients with HFpEF from the PARAGON-HF cohort. They also looked at the impact of the assigned treatment on hs-TnT.
Lower hsTnT value was strongly linked to the female sex; this was not the same for NT-proBNP. The value of hsTnT, on the other hand, is unaffected by a high BMI, although NT-proBNP and BNP concentrations are much lower in obese people. Over the course of 16 weeks, sacubitril/valsartan reduced NT-proBNP concentrations by 19%, whereas hsTnT fell by 9%. In patients with atrial fibrillation (AF), sacubitril/valsartan reduced circulating NT-proBNP levels to a lesser extent, but no such pattern was observed for hsTnT. Furthermore, preceding AF increased NT-proBNP, whereas hsTnT had no such effect.
This study discovered that having higher baseline hs-TnT was linked to a higher risk of CVD/HHF, whereas having lower hs-TnT after 16 weeks was linked to a lower risk of CVD/HHF compared to those who had persistently elevated values. When compared to valsartan, sacubitril/valsartan dramatically lowered hs-TnT. This shows that hs-TnT may be useful in identifying HFpEF patients benefiting from sacubitril/valsartan therapy.