Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial

AimPatients with heart failure with reduced ejection fraction (HFrEF) have not been shown to benefit from statins. We hypothesized that, by limiting disease progression in stable HFrEF of ischaemic etiology, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab could reduce...

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Autores: Bayes-Genis, Antoni, Lupon, Josep, Revuelta-Lopez, Elena, Llibre, Cinta, Gastelurrutia, Paloma, Domingo, Mar, Cediel, German, Codina, Pau, Santiago-Vacas, Evelyn, Rangel-Sousa, Diego, Fernandez-Cisnal, Agustin, Minana, Gema, Mollar, Anna, Nunez, Julio
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p17491
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/17491
Access Level:acceso abierto
Palabra clave:Heart failure with reduced ejection fraction
Evolocumab
Troponin
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spelling Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trialBayes-Genis, AntoniLupon, JosepRevuelta-Lopez, ElenaLlibre, CintaGastelurrutia, PalomaDomingo, MarCediel, GermanCodina, PauSantiago-Vacas, EvelynRangel-Sousa, DiegoFernandez-Cisnal, AgustinMinana, GemaMollar, AnnaNunez, JulioHeart failure with reduced ejection fractionEvolocumabTroponinAimPatients with heart failure with reduced ejection fraction (HFrEF) have not been shown to benefit from statins. We hypothesized that, by limiting disease progression in stable HFrEF of ischaemic etiology, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab could reduce circulating troponin levels, a surrogate biomarker of myocyte injury and atherosclerosis progression. Methods and resultsThe EVO-HF multicentre prospective randomized trial compared evolocumab (420 mg/month administered subcutaneously) plus guideline-directed medical therapy (GDMT; n = 17) versus GDMT alone (n = 22) for 1 year in patients with stable coronary artery disease and left ventricular ejection fraction (LVEF) <40%, ischaemic aetiology, New York Heart Association class II, N-terminal pro-B-type natriuretic peptide (NT-proBNP) & GE;400 pg/ml, high-sensitivity troponin T (hs-TnT) >10 pg/ml, low-density lipoprotein cholesterol (LDL-C) & GE;70 mg/dl. The primary endpoint was change in hs-TnT concentration. Secondary endpoints included NT-proBNP, interleukin-1 receptor-like 1 (ST2), high-sensitivity C-reactive protein (hs-CRP), LDL, low-density lipoprotein receptor (LDLR), high-density lipoprotein cholesterol (HDL-C), and PCSK9 levels at 1 year. Patients were mainly Caucasian (71.8%), male (79.5%), relatively young (mean age 68.1 & PLUSMN; 9.4 years), with a mean LVEF of 30.4 & PLUSMN; 6.5%, and managed with contemporary treatments. No significant changes in hs-TnT levels were observed in any group at 1 year. NT-proBNP and ST2 levels decreased in the GDMT plus evolocumab group (p = 0.045 and p = 0.008, respectively), without changes in hs-CRP, HDL-C, or LDLR. Total and LDL-C decreased in both groups, significantly higher in the intervention group (p = 0.003), and PCSK9 levels increased in the intervention group. ConclusionsThis prospective randomized pilot trial, although with the limitation of the small sample size, does not support the benefit of evolocumab in reducing troponin levels in patients with elevated LDL-C levels, history of coronary artery disease, and stable HFrEF.WILEY2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/17491EUROPEAN JOURNAL OF HEART FAILUREISSN: 13889842ISSNe: 18790844reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p174912026-06-07T16:35:31Z
dc.title.none.fl_str_mv Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
title Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
spellingShingle Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
Bayes-Genis, Antoni
Heart failure with reduced ejection fraction
Evolocumab
Troponin
title_short Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
title_full Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
title_fullStr Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
title_full_unstemmed Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
title_sort Evolocumab has no effects on heart failure with reduced ejection fraction injury biomarkers: The EVO-HF trial
dc.creator.none.fl_str_mv Bayes-Genis, Antoni
Lupon, Josep
Revuelta-Lopez, Elena
Llibre, Cinta
Gastelurrutia, Paloma
Domingo, Mar
Cediel, German
Codina, Pau
Santiago-Vacas, Evelyn
Rangel-Sousa, Diego
Fernandez-Cisnal, Agustin
Minana, Gema
Mollar, Anna
Nunez, Julio
author Bayes-Genis, Antoni
author_facet Bayes-Genis, Antoni
Lupon, Josep
Revuelta-Lopez, Elena
Llibre, Cinta
Gastelurrutia, Paloma
Domingo, Mar
Cediel, German
Codina, Pau
Santiago-Vacas, Evelyn
Rangel-Sousa, Diego
Fernandez-Cisnal, Agustin
Minana, Gema
Mollar, Anna
Nunez, Julio
author_role author
author2 Lupon, Josep
Revuelta-Lopez, Elena
Llibre, Cinta
Gastelurrutia, Paloma
Domingo, Mar
Cediel, German
Codina, Pau
Santiago-Vacas, Evelyn
Rangel-Sousa, Diego
Fernandez-Cisnal, Agustin
Minana, Gema
Mollar, Anna
Nunez, Julio
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Heart failure with reduced ejection fraction
Evolocumab
Troponin
topic Heart failure with reduced ejection fraction
Evolocumab
Troponin
description AimPatients with heart failure with reduced ejection fraction (HFrEF) have not been shown to benefit from statins. We hypothesized that, by limiting disease progression in stable HFrEF of ischaemic etiology, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab could reduce circulating troponin levels, a surrogate biomarker of myocyte injury and atherosclerosis progression. Methods and resultsThe EVO-HF multicentre prospective randomized trial compared evolocumab (420 mg/month administered subcutaneously) plus guideline-directed medical therapy (GDMT; n = 17) versus GDMT alone (n = 22) for 1 year in patients with stable coronary artery disease and left ventricular ejection fraction (LVEF) <40%, ischaemic aetiology, New York Heart Association class II, N-terminal pro-B-type natriuretic peptide (NT-proBNP) & GE;400 pg/ml, high-sensitivity troponin T (hs-TnT) >10 pg/ml, low-density lipoprotein cholesterol (LDL-C) & GE;70 mg/dl. The primary endpoint was change in hs-TnT concentration. Secondary endpoints included NT-proBNP, interleukin-1 receptor-like 1 (ST2), high-sensitivity C-reactive protein (hs-CRP), LDL, low-density lipoprotein receptor (LDLR), high-density lipoprotein cholesterol (HDL-C), and PCSK9 levels at 1 year. Patients were mainly Caucasian (71.8%), male (79.5%), relatively young (mean age 68.1 & PLUSMN; 9.4 years), with a mean LVEF of 30.4 & PLUSMN; 6.5%, and managed with contemporary treatments. No significant changes in hs-TnT levels were observed in any group at 1 year. NT-proBNP and ST2 levels decreased in the GDMT plus evolocumab group (p = 0.045 and p = 0.008, respectively), without changes in hs-CRP, HDL-C, or LDLR. Total and LDL-C decreased in both groups, significantly higher in the intervention group (p = 0.003), and PCSK9 levels increased in the intervention group. ConclusionsThis prospective randomized pilot trial, although with the limitation of the small sample size, does not support the benefit of evolocumab in reducing troponin levels in patients with elevated LDL-C levels, history of coronary artery disease, and stable HFrEF.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/17491
url https://incliva.portalinvestigacion.com/publicaciones/17491
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv EUROPEAN JOURNAL OF HEART FAILURE
ISSN: 13889842
ISSNe: 18790844
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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