Almufleh Aws, Marbach Jeffrey, Chih Sharon, Stadnick Ellamae, Davies Ross, Liu Peter, Mielniczuk Lisa
Division of Cardiology, University of Ottawa Heart InstituteOttawa, Ontario, Canada.
Department of Cardiac Sciences, King Saud UniversityRiyadh, Saudi Arabia.
Am J Cardiovasc Dis. 2017 Dec 20;7(6):108-113. eCollection 2017.
Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). The effect of Sacubitril/Valsartan on ejection fraction (EF) and reverse remodeling parameters have not been previously described.
We performed a single-center, retrospective, cohort study of HFrEF patients (n=48) who were treated with Sacubitril/Valsartan for a median duration of 3 months (Interquartile range 2-6 months). Clinical and echocardiographic parameters were reviewed at three time points (pre-baseline which was median of 18 months before starting Sacubitril/Valsartan, baseline before treatment started, and post-Sacubitril/Valsartan). Paired sample t-test and one-way repeated measures ANOVA were used for normally distributed data, while Wilcoxon Signed Rank test for non-normally distributed data.
Sacubitril/Valsartan use was associated with an average 5% (±1.2) increase in EF, from a mean baseline of 25.33% to 30.14% (p<0.001) with a median duration of treatment 3 months. There was no significant change in mean LVEF over a median duration of 11 months (IQR 5.5-15.5) between pre-baseline and baseline time points prior to treatment (p=1.0). The mean increase in ejection fraction tended to be marginally greater in the medium/high dose cohort as compared to the low dose cohort, with a mean increase of 5.09% (±1.36) and 4.03% (±3.17), respectively (p=0.184). There was a 3.36 mm reduction in left ventricular end-systolic diameter (p=0.04), a 2.64 mm reduction in left ventricular end-diastolic diameter (p=0.02), and a 14.4 g/m reduction in left ventricular mass index (p<0.01).
Sacubitril/Valsartan was found to improve EF and multiple measures of reverse remodeling beyond the effects of concomitant optimal medical therapy. Though these results are encouraging, our small sample, observational study requires confirmation in larger cohorts with longer follow-up periods.
沙库巴曲缬沙坦已被证明可改善射血分数降低的心力衰竭（HFrEF）患者的死亡率并减少住院次数。此前尚未描述沙库巴曲缬沙坦对射血分数（EF）和逆向重构参数的影响。
我们对48例接受沙库巴曲缬沙坦治疗的HFrEF患者进行了一项单中心、回顾性队列研究，治疗中位持续时间为3个月（四分位间距2 - 6个月）。在三个时间点（开始使用沙库巴曲缬沙坦前18个月的中位时间作为基线前，治疗开始前的基线，以及使用沙库巴曲缬沙坦后）回顾临床和超声心动图参数。对于正态分布数据，使用配对样本t检验和单因素重复测量方差分析，对于非正态分布数据，使用Wilcoxon符号秩检验。
使用沙库巴曲缬沙坦后，EF平均增加5%（±1.2），从平均基线的25.33%增至30.14%（p<0.001），治疗中位持续时间为3个月。在治疗前的基线前和基线时间点之间，中位持续时间为11个月（四分位间距5.5 - 15.5）的平均左心室射血分数（LVEF）无显著变化（p = 1.0）。与低剂量队列相比，中/高剂量队列中射血分数的平均增加幅度略大，分别为5.09%（±1.36）和4.03%（±3.17）（p = 0.184）。左心室收缩末期内径减少3.36 mm（p = 0.04），左心室舒张末期内径减少2.64 mm（p = 0.02），左心室质量指数减少14.4 g/m（p<0.01）。
发现沙库巴曲缬沙坦除了具有伴随的最佳药物治疗效果外，还可改善EF和多种逆向重构指标。尽管这些结果令人鼓舞，但我们的小样本观察性研究需要在更大队列、更长随访期的研究中得到证实。
