JACC. Case reports · 2026
Durable Remission After Triple Therapy in New-Onset HFrEF: Implications for a Strategy of "Personalized GDMT".
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Pitonak Michael, Munch Jake, Thibodeau Jennifer T, Drazner Mark H
Аннотация
BACKGROUND: Although quadruple guideline-directed medical therapy (GDMT) improves outcomes in heart failure with reduced ejection fraction (HFrEF), the optimal method to initiate and sequence quadruple therapy remains uncertain.
CASE SUMMARY: Two patients with new-onset HFrEF achieved remission with symptom resolution and near-normalization of left ventricular ejection fraction and elevated N-terminal-pro-B-type natriuretic peptide levels after administration of angiotensin-converting enzyme inhibitor, beta-blocker, and mineralocorticoid receptor antagonist, without angiotensin receptor-neprilysin inhibitor or sodium glucose cotransporter-2 inhibitor. One patient received cardiac resynchronization therapy, and the other patient stopped using alcohol and prescription amphetamine/dextroamphetamine (Adderall). Remission has lasted ≥12 years in both patients.
DISCUSSION: Methods are needed to identify which patients with new-onset HFrEF can achieve remission with fewer drugs than quadruple therapy. This personalized GDMT strategy would reduce costs and the risks of drug-related side effects.
TAKE-HOME MESSAGE: Durable remission from new-onset HFrEF can be achieved with fewer drugs than quadruple GDMT. Diagnostic tools are needed to identify such patients.
CASE SUMMARY: Two patients with new-onset HFrEF achieved remission with symptom resolution and near-normalization of left ventricular ejection fraction and elevated N-terminal-pro-B-type natriuretic peptide levels after administration of angiotensin-converting enzyme inhibitor, beta-blocker, and mineralocorticoid receptor antagonist, without angiotensin receptor-neprilysin inhibitor or sodium glucose cotransporter-2 inhibitor. One patient received cardiac resynchronization therapy, and the other patient stopped using alcohol and prescription amphetamine/dextroamphetamine (Adderall). Remission has lasted ≥12 years in both patients.
DISCUSSION: Methods are needed to identify which patients with new-onset HFrEF can achieve remission with fewer drugs than quadruple therapy. This personalized GDMT strategy would reduce costs and the risks of drug-related side effects.
TAKE-HOME MESSAGE: Durable remission from new-onset HFrEF can be achieved with fewer drugs than quadruple GDMT. Diagnostic tools are needed to identify such patients.