Personalised Prospective Comparison of ARni With ArB in Patients With Natriuretic Peptide eLEvation (PARABLE)
Atrial Remodeling, Myocardial Dysfunction, Left Ventricular Remodeling
About this trial
This is an interventional prevention trial for Atrial Remodeling focused on measuring Natriuretic peptide, Atrial remodelling, Atrial cardiomyopathy, Asymptomatic left ventricular diastolic dysfunction, Preserved ejection fraction, Myocardial fibrosis, Myocardial inflammation, Ventricular dysfunction
Eligibility Criteria
Inclusion Criteria:
Age > 40yrs with cardiovascular risk factor(s) including at least one of:
- History of hypertension (medicated for greater than one month);
- History of diabetes;
- Elevated NP: Elevated NP: BNP between 20 and 280pg/ml or NT-proBNP values between 100 pg/ml and 1,000 pg/ml within 6 months prior to screening or at screening
- LAVI > 28 mL/m2 obtained during Doppler Echocardiography within 6 months prior to screening or at screening
- Subjects must give written informed consent to participate in the study and before any study related assessments are performed.
Exclusion Criteria:
- A history of heart failure.
- Asymptomatic left ventricular systolic dysfunction defined as LVEF <50% on most recent measurement.
- Systolic blood pressure <100mmHg
- Persistent atrial fibrillation.
- History of hypersensitivity, allergy or intolerance to LCZ696, ARB or neprilysin therapy or to any of the excipients or other contraindication to their use.
- Previous history of intolerance to recommended target doses for ARBs
- Subjects who require treatment with both an ACE inhibitor and an ARB
- Presence of haemodynamically significant mitral and /or aortic valve disease.
- Presence of hemodynamically significant obstructive lesions of left ventricular outflow tract, including aortic stenosis.
- Conditions that are expected to compromise survival over the study period.
- Serum potassium level > 5.2 mmol/L at screening.
- Severe renal insufficiency (eGFR <30 mL per minute per 1.73 m2).
- Hepatic dysfunction (Any LFT > 3 times the upper limit of normal (ULN))
- Concomitant use of aliskiren
- History of angioedema.
- History or evidence of drug or alcohol abuse within the last 12 months
- Malignancy or presence of any other disease with a life expectancy of < 2 years
- Women who are pregnant, breast-feeding, or women of child bearing potential not using estro-progestative oral or intra-uterine contraception or implants, or women using estro-progestative oral or intra-uterine contraception or implants but who consider stopping it during the planned duration of the study. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. (Contraception must be continued for one week following discontinuation of study drug).
- Concomitant participation in other intervention trials
- Participation in any investigational drug trial within one month of visit 1.
- Refusal to provide informed consent
Subjects with contraindications to MRI
- Brain aneurysm clip
- Implanted neural stimulator
- Implanted cardiac pacemaker or defibrillator
- Cochlear implant
- Ocular foreign body (e.g. metal shavings)
- Other implanted medical devices: (e.g. Swan-Ganz catheter)
- Insulin pump
- Metal shrapnel or bullet.
Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs, including but not limited to any of the following:
- History of major gastrointestinal tract surgery including gastrectomy, gastroenterostomy, or bowel resection.
- Inflammatory bowel disease during the 12 months prior to Visit 1.
- Any history of pancreatic injury, pancreatitis or evidence of impaired pancreatic function/injury as indicated by abnormal lipase or amylase.
- Evidence of hepatic disease as determined by any one of the following: SGOT or SGPT values exceeding 3 x ULN at Visit 1, a history of hepatic encephalopathy, a history of oesophageal varices, or a history of portocaval shunt.
Sites / Locations
- The STOP-HF Service, St Michael's Hosptial
- St Vincents University Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Control
Intervention
Valsartan 40mg bid titrated to maximum dose of 160mg bid
Sacubitril/Valsartan 50mg bid titrated to maximum dose of 200mg bid