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"A multistep screening strategy is suggested in which patients with red flags for CA undergo both a light chain assay and technetium-labeled cardiac scintigraphy (technetium-labeled cardiac scintigraphy scan), which, when negative, rule out CA," they wrote. We investigated these differences in the PARAGON-HF trial. Oghina and colleagues maintained that HFpEF trials should routinely exclude patients with CA to ensure more uniform populations that may be more responsive to pharmacotherapies. Background Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. A panel of experts converse about the impact of guideline-directed therapy, as well as the use of spironolactone and sacubitril/valsartan for patients with heart failure with preserved ejection fraction. The net effect led to restrict patient eligibility to enrolment, by excluding those HFpEF subjects without structural heart changes and clinical or biological (BNPNT-proBNP. Additional analyses led by Packer showed that in patients with ejection fractions below 65, the HHF benefit from empagliflozin consistently. Guideline-Directed Therapy for HFpEF and the Use of Spironolactone and Sacubitril/Valsartan. The trial entry criteria changes were strictly focused in reinforcing the fact that the investigated HFpEF subjects had to have unequivocal HF signs and symptoms. Ejection Fraction) randomly assigned 4,796 patients with HFpEF (45) to. However, the prevalence of CA in the general population of patients with HFpEF remains underestimated, and the impact of disease prevalence on sensitivity and specificity remains debated," the group argued. This apparent attenuation of an effect at higher ejection fractions has been observed in other HFpEF trials, most recently in the PARAGON-HF trial of sacubitril/valsartan (Entresto), he noted. in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial. PARADIGM-HF, which evaluated sacubitril-valsartan vs enalapril in patients with heart failure with reduced ejection fraction (HFrEF), reported a decrease in mortality, risk of hospitalization for heart failure, symptoms and physical limitations in such patients. "We acknowledge that, as recruitment occurred in a tertiary center for CA, the prevalence of the disease in our population was probably higher than in the general population with HFpEF or in clinical trial candidates.