a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
b Cardiac, Thoracic and Vascular Department , University of Pisa , Pisa , Italy.
Curr Med Res Opin. 2019 May;35(sup3):13-18. doi: 10.1080/03007995.2019.1598702.
Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor, was shown to improve outcome in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). There are reasons for believing that the concept that the lower the B-type natriuretic peptide (BNP) circulating level the better the prognosis may no longer be correct in patients treated with sacubitril/valsartan, since sacubitril may interfere with BNP clearance. We reported a case series of ten patients with stable chronic HF and LVEF ≤35% (mean age: 64 ± 8 years; 30% female), referred to our outpatient HF clinic, treated with sacubitril/valsartan, in whom the global amelioration of NYHA class and LVEF was coupled with a clinically significant decrease in BNP levels and a reduction of loop diuretic dose. Average sacubitril/valsartan daily dose was 220 mg. The median duration of treatment was 15 months (range: 6-21 months). Seventy percent of patients exhibited an improvement in exercise tolerance, as indicated by the change in NYHA class. There was also an improvement in LVEF from 28 ± 5% to 39 ± 7%. Clinically significant reductions in BNP levels were evident, with a median change from 181 pg/ml to 70 pg/ml. Furosemide daily dose decreased from a median of 43.3 mg to 12.5 mg. This case series suggests that BNP may still be valuable for the assessment of ambulatory HF patients, after the optimization of sacubitril/valsartan therapy.
沙库巴曲缬沙坦，一种血管紧张素受体脑啡肽酶抑制剂，已被证明可改善射血分数降低的心力衰竭（HF）患者的预后。有理由相信，对于接受沙库巴曲缬沙坦治疗的患者，循环 B 型利钠肽（BNP）水平越低预后越好的概念可能不再正确，因为沙库巴曲可能会干扰 BNP 的清除。我们报告了一组 10 例稳定的慢性 HF 和 LVEF≤35%（平均年龄：64±8 岁；30%为女性）的患者的病例系列，这些患者被转诊至我们的门诊 HF 诊所，接受沙库巴曲缬沙坦治疗，其 NYHA 心功能分级和 LVEF 全面改善与 BNP 水平的临床显著下降和袢利尿剂剂量减少相关。沙库巴曲缬沙坦的平均日剂量为 220mg。治疗的中位持续时间为 15 个月（范围：6-21 个月）。70%的患者 NYHA 心功能分级的改变表明其运动耐量得到改善。LVEF 也从 28±5%改善至 39±7%。BNP 水平的临床显著降低，中位数从 181pg/ml 降至 70pg/ml。呋塞米的日剂量从中位数 43.3mg 降至 12.5mg。本病例系列研究表明，在优化沙库巴曲缬沙坦治疗后，BNP 对于评估门诊 HF 患者仍有价值。
