#VisualAbstract: Effect of Neladenoson Bialanate on Exercise Capacity Among Patients With Heart Failure With Preserved Ejection Fraction

1. In this randomized controlled trial, heart failure with preserved ejection fraction (HFpEF) patients did not have improved exercise capacity with neladenoson versus placebo.

2. There were no changes in activity intensity, NT-proBNP level, high-sensitivity troponin T level, or quality of life with neladenoson.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Heart failure with preserved ejection fraction (HFpEF) has high mortality and morbidity, including low exercise capacity. Neladenoson bialanate is a partial adenosine A1 receptor agonist that improves mitochondrial function and reverses ventricular remodeling, but it is unclear if it is beneficial for HFpEF. In this randomized clinical trial, neladenoson did not improve exercise capacity in patients with HFpEF over a 20 week period compared with placebo. In addition, neladenoson did not improve activity intensity, NT-proBNP level, high-sensitivity troponin T level, or quality of life. Serious adverse effects were similar among groups.

Though the study suggests neladenoson does not benefit HFpEF patients, some limitations should be noted. First, it is possible that longer treatment periods were needed to see an effect. Second, the lack of preclinical HFpEF models and mechanistic studies of neladenoson in humans obscures whether improvements in mitochondrial respiration were achieved in the clinical setting.

Click to read the study in JAMA

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