Cardiac Troponin and Treatment Effects of Omecamtiv Mecarbil: Results From the GALACTIC-HF Study
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Cardiac Troponin and Treatment Effects of Omecamtiv Mecarbil : Results From the GALACTIC-HF Study. / Felker, G. Michael; Solomon, Scott D.; Metra, Marco; Mcmurray, John J.V.; Diaz, Rafael; Claggett, Brian; Lanfear, David E.; Vandekerckhove, Hans; Biering-Sørensen, Tor; Lopes, Renato D.; Arias-Mendoza, Alexandra; Momomura, Shin Ichi; Corbalan, Ramon; Ramires, Felix J.A.; Zannad, Faiez; Heitner, Stephen B.; Divanji, Punag H.; Kupfer, Stuart; Malik, Fady I.; Teerlink, John R.
In: Journal of Cardiac Failure, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Cardiac Troponin and Treatment Effects of Omecamtiv Mecarbil
T2 - Results From the GALACTIC-HF Study
AU - Felker, G. Michael
AU - Solomon, Scott D.
AU - Metra, Marco
AU - Mcmurray, John J.V.
AU - Diaz, Rafael
AU - Claggett, Brian
AU - Lanfear, David E.
AU - Vandekerckhove, Hans
AU - Biering-Sørensen, Tor
AU - Lopes, Renato D.
AU - Arias-Mendoza, Alexandra
AU - Momomura, Shin Ichi
AU - Corbalan, Ramon
AU - Ramires, Felix J.A.
AU - Zannad, Faiez
AU - Heitner, Stephen B.
AU - Divanji, Punag H.
AU - Kupfer, Stuart
AU - Malik, Fady I.
AU - Teerlink, John R.
PY - 2024
Y1 - 2024
N2 - Background: Omecamtiv mecarbil improves outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We examined the relationship between baseline troponin levels, change in troponin levels over time and the treatment effect of omecamtiv mecarbil in patients enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes through Improving Contractility in Heart Failure (GALACTIC-HF) trial (NCT02929329). Methods: GALACTIC-HF was a double-blind, placebo-controlled trial that randomized 8256 patients with symptomatic HFrEF to omecamtiv mecarbil or placebo. High-sensitivity troponin I (cTnI) was measured serially at a core laboratory. We analyzed the relationship between both baseline cTnI and change in cTnI concentrations with clinical outcomes and the treatment effect of omecamtiv mecarbil. Results: Higher baseline cTnI concentrations were associated with a risk of adverse outcomes (hazard ratio for the primary endpoint of time to first HF event or CV death = 1.30; 95% CI 1.28, 1.33; P < 0.001 per doubling of baseline cTnI). Although the incidence of safety outcomes was higher in patients with higher baseline cTnI, there was no difference between treatment groups. Treatment with omecamtiv mecarbil led to a modest increase in cTnI that was related to plasma concentrations of omecamtiv mecarbil, and it peaked at 6 weeks. An increase in troponin from baseline to week 6 was associated with an increased risk of the primary endpoint (P < 0.001), which was similar, regardless of treatment assignment (P value for interaction = 0.2). Conclusions: In a cohort of patients with HFrEF, baseline cTnI concentrations were strongly associated with adverse clinical outcomes. Although cTnI concentrations were higher in patients treated with omecamtiv mecarbil, we did not find a differential effect of omecamtiv mecarbil on either safety or efficacy based on baseline cTnI status or change in cTnI.
AB - Background: Omecamtiv mecarbil improves outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We examined the relationship between baseline troponin levels, change in troponin levels over time and the treatment effect of omecamtiv mecarbil in patients enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes through Improving Contractility in Heart Failure (GALACTIC-HF) trial (NCT02929329). Methods: GALACTIC-HF was a double-blind, placebo-controlled trial that randomized 8256 patients with symptomatic HFrEF to omecamtiv mecarbil or placebo. High-sensitivity troponin I (cTnI) was measured serially at a core laboratory. We analyzed the relationship between both baseline cTnI and change in cTnI concentrations with clinical outcomes and the treatment effect of omecamtiv mecarbil. Results: Higher baseline cTnI concentrations were associated with a risk of adverse outcomes (hazard ratio for the primary endpoint of time to first HF event or CV death = 1.30; 95% CI 1.28, 1.33; P < 0.001 per doubling of baseline cTnI). Although the incidence of safety outcomes was higher in patients with higher baseline cTnI, there was no difference between treatment groups. Treatment with omecamtiv mecarbil led to a modest increase in cTnI that was related to plasma concentrations of omecamtiv mecarbil, and it peaked at 6 weeks. An increase in troponin from baseline to week 6 was associated with an increased risk of the primary endpoint (P < 0.001), which was similar, regardless of treatment assignment (P value for interaction = 0.2). Conclusions: In a cohort of patients with HFrEF, baseline cTnI concentrations were strongly associated with adverse clinical outcomes. Although cTnI concentrations were higher in patients treated with omecamtiv mecarbil, we did not find a differential effect of omecamtiv mecarbil on either safety or efficacy based on baseline cTnI status or change in cTnI.
KW - clinical trials
KW - Heart failure
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85185181115&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2023.11.021
DO - 10.1016/j.cardfail.2023.11.021
M3 - Journal article
C2 - 38215932
AN - SCOPUS:85185181115
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
SN - 1071-9164
ER -
ID: 384419515