Heart failure & cardiomyopathies
Left Ventricular Function Improvement During Angiotensin Receptor–Neprilysin Inhibitor Treatment in a Cohort of HFrEF/HFmrEF Patients
Authors' conclusion
Recognition of essential clinical factors by integrating machine learning and cluster analyses may help to identify HF patients benefiting from improvement of LVEF following ARNI treatment. Early identification of those patients with a high response to ARNI treatment may allow a more refined selection of patients benefiting from an early escalation of HF treatment or interventional therapy.
Study context
- Population
- Patients with heart failure with reduced (HFrEF) or mildly reduced (HFmrEF) ejection fraction on angiotensin receptor-neprilysin inhibitor (ARNI) treatmentconsecutive patients in the 'EnTruth' patient registry
- Participants
- 294 patients
- Predictors
- Clinically relevant patient-, heart failure (HF)- and treatment-related parameters
- Predicted outcome
- LVEF improvement (cardiac remodelling) following ARNI treatment
Methodological details'EnTruth', consecutive patients, medoid clustering, XGBoost machine learning algorithm
- 'EnTruth'
- Consecutive patients
- Medoid clustering
- XGBoost machine learning algorithm
Model performance
As reported in the abstract
12 months of follow-up
AUC
HFrEF (validation cohort)
0.77
HFmrEF (validation cohort)
0.70
- XGBoost model; validation cohort
Further findings
| Outcome | HFrEF | HFmrEF |
|---|---|---|
| EnTruth score vs absolute LVEF improvement | 0.51 | 0.42 |
| P | P < 0.0001 | P = 0.001 |
Cluster analysis
- Four characteristic sub-phenotypes of patients with HFrEF and HFmrEF; distinct clusters exhibit a strong therapeutic response to ARNI and enhanced left ventricular (LV) function
- P < 0.05
Patient criteria associated with change of LVEF
- Duration and aetiology of HF, renal function and de novo ARNI treatment significantly associated with change of LVEF and independently predicted cardiac remodelling
- P < 0.05
All-cause mortality, HFrEF with high EnTruth score
- Lower risk of all-cause mortality with a high EnTruth score
- P < 0.05
- Survival analysis
Original publication
Left Ventricular Function Improvement During Angiotensin Receptor–Neprilysin Inhibitor Treatment in a Cohort of HFrEF/HFmrEF Patients. ESC Heart Fail. Published 20 January 2025. doi:10.
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