a Centro Cardiologico Monzino, IRCCS , Milan , Italy.
b Cardiovascular Section, Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy.
Curr Med Res Opin. 2019 Mar;35(sup1):3-5. doi: 10.1080/03007995.2019.1576480.
The cardiopulmonary exercise test (CPET) provides functional prognostic parameters for patients with chronic heart failure (CHF), such as peak volume of oxygen (VO) and minute ventilation/carbon dioxide production (VE/VCO) slope. Sacubitril/valsartan (LCZ696) has been recently approved for CHF patients as it reduces cardiovascular (CV) deaths and hospitalization for heart failure (HF). However, the potential beneficial effects of this therapy on exercise performance have been poorly investigated to date.
We present a 64 year old woman with systolic HF (New York Heart Association [NYHA] class III, ejection fraction 35%) due to moderate/severe aortic and tricuspid regurgitation and pulmonary hypertension. The patient had several co-morbidities and a history of CV surgery (mitral valve replacement due to bacterial endocarditis). In November 2016, a CPET was performed in stable clinical conditions, showing severe cardiogenic limitation with signs of pulmonary hypertension (peak VO 46% of predicted, VE/VCO slope 36.5). According to current guidelines, an angiotensin-converting enzyme inhibitor was replaced with sacubitril/valsartan (24/26 mg for 2 weeks and then increased to 49/51 mg) without any other change in medical therapy. At 2 months, CPET showed improvement in exercise performance (peak VO 61%, VE/VCO slope 26.9). Echocardiographic parameters also showed mild improvement, whereas renal function remained unchanged. Thus, the dose of sacubitril/valsartan was increased to 97/103 mg.
We present a case of a systolic HF patient successfully treated with sacubitril/valsartan who showed a rapid improvement of exercise performance at CPET.
心肺运动试验（CPET）为慢性心力衰竭（CHF）患者提供了功能预后参数，例如峰值摄氧量（VO）和分钟通气量/二氧化碳产量（VE/VCO）斜率。沙库巴曲缬沙坦（LCZ696）最近被批准用于 CHF 患者，因为它降低了心血管（CV）死亡和心力衰竭（HF）住院的风险。然而，迄今为止，这种治疗对运动表现的潜在有益影响尚未得到充分研究。
我们介绍了一位 64 岁女性，因中度/重度主动脉瓣和三尖瓣反流和肺动脉高压导致射血分数为 35%的收缩性 HF（纽约心脏协会 [NYHA] 心功能分级 III 级）。该患者有多种合并症和 CV 手术史（因细菌性心内膜炎行二尖瓣置换术）。2016 年 11 月，在稳定的临床条件下进行了 CPET，结果显示严重的心源性限制，伴有肺动脉高压迹象（峰值 VO 为预测值的 46%，VE/VCO 斜率为 36.5）。根据现行指南，将血管紧张素转换酶抑制剂替换为沙库巴曲缬沙坦（24/26mg，持续 2 周，然后增加至 49/51mg），而不改变其他药物治疗。2 个月后，CPET 显示运动表现改善（峰值 VO 为 61%，VE/VCO 斜率为 26.9）。超声心动图参数也显示出轻微改善，而肾功能保持不变。因此，将沙库巴曲缬沙坦的剂量增加至 97/103mg。
我们介绍了一例成功接受沙库巴曲缬沙坦治疗的收缩性 HF 患者的病例，该患者在 CPET 中显示出运动表现的快速改善。
