Department of Translational Medical Sciences, University of Naples 'Federico II', 80131, Naples, Italy.
Department of Cardiovascular Surgery and Transplant, Monaldi Hospital, Azienda dei Colli, 80131, Naples, Italy.
ESC Heart Fail. 2020 Apr;7(2):757-762. doi: 10.1002/ehf2.12610. Epub 2020 Feb 19.
The aim of this study was to investigate prospectively the effect of sacubitril/valsartan in advanced heart failure (HF) patients in waiting list for heart transplantation (HT) and the effect on physical frailty (PF).
We treated 37 consecutive patients with advanced HF with sacubitril/valsartan. Patients were followed up until HT, device implant, or last follow-up visit after 2 years of follow-up. At baseline, mean New York Heart Association (NYHA) class was 3.1 ± 0.4, with 64.9% in NYHA III and 35.1% NYHA IIIB. Left ventricular ejection fraction was 23.5 ± 5.8%, VO max was 10.3 ± 2.3 mL/kg/min, cardiac index was 2.3 ± 0.5 L/min/m , and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) was 4943.0 ± 5326.8 pg/mL. After a mean follow-up of 17.1 ± 4.4 months, no deaths were observed, but NYHA class improved significantly with 56.8% in NYHA II, 40.5% in NYHA III, and 2.7% in NYHA IIIB (P < 0.001). VO max and 6 min walk test (6MWT) increased, whereas pulmonary systolic blood pressure, E/E', VE/VCO slope, and NT-pro-BNP decreased. At right heart catheterization performed after 1 year of follow-up, cardiac index and pulmonary vascular resistance remained stable, while a decrease in systolic pulmonary artery pressure and pulmonary capillary wedge pressure is observed. Furosemide dosage decrease from 102.7 ± 69.4 to 78.7 ± 66.3 mg (P = 0.040). PF decreased from 3.35 ± 1.0 at baseline to 1.57 ± 1.3 at the end of follow-up (P < 0.001), with a reduction in all PF domains.
Our study showed a rapid improvement in PF in HT waiting list patients treated with sacubitril/valsartan. The improvement in all PF domains was paralleled by VO and 6MWT increase and together with an NT-pro-BNP reduction constant over the follow-up.
本研究旨在前瞻性研究沙库巴曲缬沙坦在等待心脏移植（HT）的晚期心力衰竭（HF）患者中的作用，以及对身体虚弱（PF）的影响。
我们对 37 例晚期 HF 患者连续给予沙库巴曲缬沙坦治疗。患者随访至 HT、器械植入或随访 2 年后的最后一次随访。基线时，平均纽约心脏协会（NYHA）心功能分级为 3.1 ± 0.4 级，其中 64.9%为 NYHA III 级，35.1%为 NYHA IIIB 级。左室射血分数为 23.5 ± 5.8%，VO max 为 10.3 ± 2.3 mL/kg/min，心指数为 2.3 ± 0.5 L/min/m，N 末端脑利钠肽前体（NT-pro-BNP）为 4943.0 ± 5326.8 pg/mL。平均随访 17.1 ± 4.4 个月后，未观察到死亡，但 NYHA 心功能分级显著改善，NYHA II 级占 56.8%，NYHA III 级占 40.5%，NYHA IIIB 级占 2.7%（P < 0.001）。VO max 和 6 分钟步行试验（6MWT）增加，而肺动脉收缩压、E/E'、VE/VCO 斜率和 NT-pro-BNP 降低。在随访 1 年后进行的右心导管检查中，心指数和肺血管阻力保持稳定，而收缩肺动脉压和肺毛细血管楔压降低。速尿剂量从 102.7 ± 69.4 减少到 78.7 ± 66.3 mg（P = 0.040）。PF 从基线时的 3.35 ± 1.0 下降到随访结束时的 1.57 ± 1.3（P < 0.001），所有 PF 领域均下降。
本研究显示，在等待 HT 的患者中，沙库巴曲缬沙坦治疗可迅速改善 PF。PF 所有领域的改善与 VO 和 6MWT 的增加以及 NT-pro-BNP 的持续减少相一致。
