Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan; National Defense Medical Center, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taipei, Taiwan.
J Cardiol. 2020 Mar;75(3):233-241. doi: 10.1016/j.jjcc.2019.08.005. Epub 2019 Sep 26.
Literature describing recovery of left ventricular (LV) function post sacubitril/valsartan treatment and the optimal management of heart failure (HF) patients receiving sacubitril/valsartan remain sparse.
We recruited 437 consecutive chronic HF patients with baseline left ventricular ejection fraction (LVEF) less than 40%, who were treated with sacubitril/valsartan. All patients underwent routine echocardiographic measurement.
During treatment period, recovery of LVEF to 50% or greater was observed in 77 (17.6%) patients. After multivariate analysis, recovery of LV dysfunction was associated with non-ischemic etiology of HF, smaller baseline LV end-diastolic diameter (LVEDD), and higher initial dosage of sacubitril/valsartan. Compared to those without recovery of LV dysfunction, death from cardiovascular causes or first unplanned hospitalization for HF (CVD/HFH) were significantly lower in patients with LVEF recovery [11.7% vs. 24.4%, hazard ratio (HR) 0.42, p = 0.014]. Among patients with recovery of LVEF, 51 patients continued to receive the same dosage of sacubitril/valsartan had higher LVEF and were less likely to have deterioration of LVEF than the other 26 patients who received either tapering dose of sacubitril/valsartan or switching from sacubitril/valsartan to renin-angiotensin-system blockers (LVEF 56.4 ± 5.3% vs. 45.0 ± 12.8%, p < 0.001; ΔLVEF 1.2 ± 5.1% vs. -9.3 ± 12.0%, p < 0.001). CVD/HFH occurred more frequently in the taper group than the maintenance group (23.1% vs. 5.9%, HR 0.22, p = 0.035).
Non-ischemic etiology of HF, smaller baseline LVEDD, and higher initial dosage of sacubitril/valsartan could predict better recovery of LV function. Among patients with functional recovery, tapering sacubitril/valsartan dose was associated with deterioration of recovered heart function and had less favorable prognosis during follow-up.
描述沙库巴曲缬沙坦治疗后左心室（LV）功能恢复情况以及心力衰竭（HF）患者接受沙库巴曲缬沙坦最佳管理的文献仍然很少。
我们招募了 437 例连续的慢性 HF 患者，这些患者的基线左心室射血分数（LVEF）小于 40%，并接受沙库巴曲缬沙坦治疗。所有患者均接受常规超声心动图测量。
在治疗期间，77 例（17.6%）患者的 LVEF 恢复至 50%或更高。多变量分析后，LV 功能障碍的恢复与 HF 的非缺血病因、较小的基线 LV 舒张末期直径（LVEDD）和较高的沙库巴曲缬沙坦初始剂量相关。与 LV 功能障碍未恢复的患者相比，LVEF 恢复的患者因心血管原因或首次计划外 HF 住院（CVD/HFH）而死亡的风险显著降低[11.7%比 24.4%，风险比（HR）0.42，p=0.014]。在 LVEF 恢复的患者中，51 例继续接受相同剂量的沙库巴曲缬沙坦，其 LVEF 更高，且与其他 26 例接受沙库巴曲缬沙坦剂量递减或从沙库巴曲缬沙坦转换为肾素-血管紧张素系统抑制剂的患者相比，LVEF 恶化的可能性更小（LVEF 56.4±5.3%比 45.0±12.8%，p<0.001；ΔLVEF 1.2±5.1%比-9.3±12.0%，p<0.001）。递减组的 CVD/HFH 发生率高于维持组[23.1%比 5.9%，HR 0.22，p=0.035]。
HF 的非缺血病因、较小的基线 LVEDD 和较高的沙库巴曲缬沙坦初始剂量可预测 LV 功能更好的恢复。在功能恢复的患者中，沙库巴曲缬沙坦剂量递减与恢复心功能恶化有关，且在随访期间预后较差。
