Heart failure & cardiomyopathiesSecondary analysis
Impact of estimated total blood volume on NT-proBNP response to angiotensin receptor–neprilysin inhibition in acute heart failure: Insights from the PREMIER study
- post hoc exploratory sub-analysis of the PREMIER randomized trial
Authors' conclusion
In this exploratory post hoc analysis, higher estimated TBV was associated with greater NT-proBNP reduction after Sac/Val, particularly among patients with LVEF ≥40%. These findings are hypothesis-generating and require external validation.
Study context
- Population
- Patients with acute heart failure (AHF) in the PREMIER randomized trial, stratified by baseline estimated total blood volume (TBV) and left ventricular ejection fraction (LVEF <40% vs ≥40%)with baseline estimated TBV data analyzed, among 376 patients
- Participants
- 372 patients
- Comparison
- NT-proBNP reduction after Sac/Val compared with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) therapy, by baseline estimated TBV
- Primary endpoint
- Proportional change in NT-proBNP
- Follow-up
- Baseline to Week 8
Primary result
As reported in the abstract
Ratio of change
0.67
95% CI 0.53–0.84
P = 0.001
By group
Sac/Val (high TBV group)
−56%
ACEI/ARB (high TBV group)
−32%
Further findings
NT-proBNP reduction, LVEF <40% (subgroup)
- Sac/Val associated with greater NT-proBNP reduction in both TBV groups
NT-proBNP reduction, LVEF ≥40% (subgroup)
- Sac/Val associated with greater NT-proBNP reduction in the high TBV group
- Point estimate in the low TBV group numerically favored ACEI/ARB
Original publication
Impact of estimated total blood volume on NT-proBNP response to angiotensin receptor–neprilysin inhibition in acute heart failure: Insights from the PREMIER study. Am Heart J. Published 1 August 2026. doi:10.1016/j.ahj.2026.107549
Summarised from the published abstract; every number is checked against it