Right Ventricular Strain Predicts Outcome in Patients Receiving Sacubitril/Valsartan: A Sub-Analysis of DISCOVER-ARNI

Pastore, MC; Mandoli, GE; Giannoni, A; Ginetti, FR; Correale, M; Brunetti, ND; Guaricci, AI; Piscitelli, L; Degiovanni, A; Patti, G; Malagoli, A; Moderato, L; Carluccio, E; Marino, PN; Emdin, M; Cameli, M

doi:10.1002/ehf2.15297

Right Ventricular Strain Predicts Outcome in Patients Receiving Sacubitril/Valsartan: A Sub-Analysis of DISCOVER-ARNI

ESC Heart FailPublished 16 Apr 2025multicentre Italian register

Main finding · Composite of all-cause or cardiovascular mortality, heart failure hospitalization, heart transplantation, and LVAD implantationResultHazard ratio 1.15 CI 1.05–1.26

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Authors' conclusion

fwRVLS by STE holds promise as a valuable parameter to assess response to ARNI therapy in terms of overall survival, heart failure hospitalizations, heart transplantation, or LVAD implantation.

Study context

Population: Patients with heart failure and reduced ejection fraction (HFrEF) referred for treatment with angiotensin receptor/neprilysin inhibitors (ARNI), with available right ventricular STE dataHFrEF patients included in this sub-analysis, of 341 enrolled in the register
Participants: 136 patients

Exposure: Patients with events compared to those who did not experience events
Patients with eventsn = 32
Outcome: Composite of:
All-cause or cardiovascular mortality
Heart failure hospitalization
Heart transplantation
LVAD implantation
Follow-up: Mean 40 ± 18 months

Methodological detailssub-analysis of DISCOVER-ARNI register, retrospectively enrolled, prospective long-term follow-up

Sub-analysis of DISCOVER-ARNI register
Retrospectively enrolled
Prospective long-term follow-up

Main finding

As reported in the abstract

Hazard ratio

1.15

CI 1.05–1.26

P = 0.002

fwRVLS

hazard ratio 1.15 (CI 1.05–1.26); P = 0.002

Patients reaching the primary endpoint: 32
Deaths: 14
Deaths due to cardiovascular reasons (of the 14 deaths): 10
Hospitalization: 22
Heart transplantation: 3
Left ventricular assist device (LVAD) implantation: 1

Observational data: associations, not effects.

Further findings

LV end-diastolic volume at baseline

Patients with events212 ± 65 mL

Those who did not experience events174 ± 57 mL

LV end-systolic volume at baseline

Patients with events156 ± 52 mL

Those who did not experience events122 ± 49 mL

LV EF at baseline

Patients with events26 ± 5 mL

Those who did not experience events29 ± 5 mL

Systolic pulmonary artery pressure at baseline

Patients with events38 ± 11 mmHg

Those who did not experience events31 ± 8 mmHg

Outcome	Patients with events	Those who did not experience events
TAPSE at baseline	17 ± 3	19 ± 3
LV, LA and fwRVLS strain · baseline
LV strain	−7 ± 2	−8 ± 2
LA strain	11 ± 3	15 ± 7
fwRVLS	−15 ± 5	−22 ± 5

LV end-diastolic volume at baseline: P = 0.002
LV end-systolic volume at baseline: P = 0.001
LV EF at baseline: P = 0.006
Tricuspid annular plane systolic excursion (TAPSE) at baseline: P = 0.008
Systolic pulmonary artery pressure at baseline: P = 0.001
LV, left atrial (LA) and free wall right ventricular longitudinal strain (fwRVLS) strain: P = 0.002
LV, LA and fwRVLS strain: P = 0.001
LV, LA and fwRVLS strain: P = 0.007

ROC optimal cut-off of fwRVLS for predicting the combined endpoint

Optimal cut-off fwRVLS: −20%
AUC: 0.70
Kaplan-Meier curves demonstrated effective risk stratification of fwRVLS over long-term follow-up for the primary endpoint

Original publication

Right Ventricular Strain Predicts Outcome in Patients Receiving Sacubitril/Valsartan: A Sub-Analysis of DISCOVER-ARNI. ESC Heart Fail. Published 16 April 2025. doi:10.1002/ehf2.15297

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