缬沙坦添加至背景性血管紧张素转换酶抑制剂治疗对心力衰竭患者的影响：缬沙坦心力衰竭试验（Val-HeFT）结果

Effect of valsartan added to background ACE inhibitor therapy in patients with heart failure: results from Val-HeFT.

作者信息

Krum Henry, Carson Peter, Farsang Csaba, Maggioni Aldo P, Glazer Robert D, Aknay Nora, Chiang Yann-Tong, Cohn Jay N

机构信息

Monash University Medical School, Alfred Hospital, Melbourne, Australia.

出版信息

Eur J Heart Fail. 2004 Dec;6(7):937-45. doi: 10.1016/j.ejheart.2004.09.005.

DOI:10.1016/j.ejheart.2004.09.005

PMID:15556056

Abstract

AIMS

To investigate the effect of valsartan in the Valsartan-Heart Failure Trial (Val-HeFT) when added to angiotensin-converting enzyme inhibitor (ACEi) alone in patients with heart failure (HF).

METHODS

Subjects in Val-HeFT receiving ACEi but not beta-blocker at baseline were analysed; 1532 were assigned to valsartan and 1502 assigned to placebo. Primary outcome events (all-cause mortality, hospitalisation for adjudicated heart failure, sudden death with resuscitation and need for >4 h of parenteral therapy for worsening heart failure) were monitored.

RESULTS

Mortality was not affected by valsartan but morbidity endpoints were significantly reduced (36.3% in placebo, 31.0% in valsartan, p=0.002) in patients receiving an ACEi but no beta-blocker. Quality of life (QOL) was significantly improved, ejection fraction (EF) significantly increased, left ventricular (LV) diameter significantly reduced and plasma B-type natriuretic peptide, norepinephrine and aldosterone levels significantly reduced with valsartan compared to placebo. The morbidity benefit was significant in patients on ACEi doses below the median (22% reduction, p=0.003) and not statistically significant in those receiving ACEi doses above the median (14% reduction, p=0.143).

CONCLUSION

Valsartan reduces heart failure hospitalisations and slows LV remodelling in patients treated with an ACEi in the absence of beta-blockade, particularly in those on lower doses of ACEi.

摘要

目的

在缬沙坦-心力衰竭试验（Val-HeFT）中，研究缬沙坦单独添加到已接受血管紧张素转换酶抑制剂（ACEi）治疗的心力衰竭（HF）患者中的效果。

方法

对Val-HeFT中基线时接受ACEi但未接受β受体阻滞剂治疗的受试者进行分析；1532例被分配至缬沙坦组，1502例被分配至安慰剂组。监测主要结局事件（全因死亡率、因判定的心力衰竭住院、复苏成功的心脏性猝死以及因心力衰竭恶化需要>4小时肠外治疗）。

结果

在接受ACEi但未接受β受体阻滞剂治疗的患者中，缬沙坦对死亡率无影响，但发病终点显著降低（安慰剂组为36.3%，缬沙坦组为31.0%，p = 0.002）。与安慰剂相比，缬沙坦显著改善生活质量（QOL），显著增加射血分数（EF），显著减小左心室（LV）直径，并显著降低血浆B型利钠肽、去甲肾上腺素和醛固酮水平。在接受低于中位数剂量ACEi的患者中，发病获益显著（降低22%，p = 0.003），而在接受高于中位数剂量ACEi的患者中，发病获益无统计学意义（降低14%，p = 0.143）。