{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T08:07:12Z","timestamp":1767168432421,"version":"build-2238731810"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T00:00:00Z","timestamp":1671580800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2022,10,24]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We investigated the incremental advantage in terms of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reduction in patients affected by heart failure with reduced ejection fraction (HFrEF) treated with sacubitril\/valsartan (S\/V) and mineralocorticoid receptor antagonists (MRA) versus patients treated with S\/V only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive adult patients with a left ventricular ejection fraction (LVEF) of \u226440%\u2009who were followed in our outpatient clinic from January 2016 to December 2019 and treated with S\/V were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of eligible 147 patients, 99 were treated with S\/V+MRA at baseline and 48 patients were treated with S\/V. Patients treated with S\/V+MRA were significantly younger (61.5 vs 67.8 years, p=0.006), had better basal renal function (serum creatinine 1.2 vs 1.4\u2009mg\/dL, p=0.006) and lower LVEF (30.9% vs 33.1%, p=0.039). At follow-up at 8\u201316 months, 84 out of 99 patients continued to be on S\/V+MRA, and 39 out of 48 patients continued to be on S\/V. Between these two groups, at follow-up, LVEF did not vary significantly, \u0394NT-proBNP was not significantly different (\u2212215.7 vs \u2212165.9\u2009pg\/mL, p=0.93) and neither was the rate of hospitalisation for heart failure (9.5% vs 12.8%, p=0.58). Using general linear models, both age and basal NT-proBNP influenced significantly \u0394NT-proBNP (respectively, p=0.002; p=0.005), while treatment with S\/V+MRA versus S\/V only did not significantly influence \u0394NT-proBNP (p=0.462).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even with the limitations of a small retrospective study, our results generate the hypothesis that MRA might not provide any additional value in patients with HFrEF treated with S\/V. Larger studies are needed to test if MRA should remain a standard treatment in patients with HFrEF treated with S\/V.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2022-002069","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T10:48:21Z","timestamp":1671619701000},"page":"e002069","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental value of mineralocorticoid receptor antagonists in patients with heart failure with reduced ejection fraction treated with sacubitril\/valsartan"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1216-5369","authenticated-orcid":false,"given":"Annachiara","family":"Benini","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Bingel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, German Cardiology Centre Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad","family":"Neumann","sequence":"additional","affiliation":[{"name":"Institute of Biometry and Clinical Epidemiology, Charite Medical Faculty Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Edelmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Charite Universitatsmedizin Berlin Campus Virchow-Klinikum, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Sch\u00f6nrath","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, German Cardiology Centre Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Burkert","family":"Pieske","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, German Cardiology Centre Berlin, Berlin, Germany"},{"name":"Department of Internal Medicine and Cardiology, Charite Medical Faculty Berlin, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Messroghli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Cardiology, German Cardiology Centre Berlin, Berlin, Germany"},{"name":"Department of Internal Medicine and Cardiology, Charite Medical Faculty Berlin, Berlin, 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