Heart failure & cardiomyopathies
Effect of Sacubitril/Valsartan vs Valsartan on Left Atrial Volume in Patients With Pre–Heart Failure With Preserved Ejection Fraction: The PARABLE Randomized Clinical Trial
Authors' conclusion
In this trial of patients with pre-HFpEF, sacubitril/valsartan treatment was associated with a greater increase in left atrial volume index and improved markers of cardiovascular risk compared to valsartan.
Study context
- Population
- Asymptomatic patients ≥40 years with hypertension or DM, elevated BNP or NT-proBNP, left atrial volume index >28 mL/m² and EF >50% (pre-heart failure with preserved ejection fraction (pre-HFpEF)), single outpatient cardiology centre, Dublin, Ireland
- Participants
- 250 patients
- Comparison
- Sacubitril/valsartan vs valsartan
- Primary endpoint
- Maximal left atrial volume index (CMR)
Methodological detailsdouble-blind, double-dummy, single-centre
- Double-blind
- Double-dummy
- Single-centre
Primary result
As reported in the abstract
Change in maximal left atrial volume index
Sacubitril/valsartan
6.9
95% CI 0.0–13.7 · mL/m²
Valsartan
0.7
95% CI −6.3–7.7 · mL/m²
P < 0.001
Further findings
| Outcome | Sacubitril/valsartan | Valsartan | Adjusted HR (95% CI) | P value | |
|---|---|---|---|---|---|
| MACE | 4.9% | 13.3% | 0.38 (0.17–0.89) | adjusted P = .04 | |
| 0.10.31310Adjusted hazard ratio (log scale) |
| Outcome | Sacubitril/valsartan | Valsartan | P value |
|---|---|---|---|
| Change in pulse pressure | −4.2 (95% CI −7.2–-1.21) mm Hg | −1.2 (95% CI −4.1–1.7) mm Hg | P < 0.001 |
| Change in NT-proBNP | −17.7% (95% CI −36.9–7.4) | 9.4% (95% CI −15.6–4.9) | P < 0.001 |
Original publication
Effect of Sacubitril/Valsartan vs Valsartan on Left Atrial Volume in Patients With Pre–Heart Failure With Preserved Ejection Fraction: The PARABLE Randomized Clinical Trial. JAMA Cardiol. Published 1 April 2023. doi:10.
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