Russo Vincenzo, Bottino Roberta, Rago Anna, Papa Andrea Antonio, Liccardo Biagio, Proietti Riccardo, Manna Vincenzo, Golino Paolo, D'Onofrio Antonio, Nigro Gerardo
Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", via Leonardo Bianchi, 80131 Naples, Italy.
Department of Cardiology, Monaldi Hospital, via Leonardo Bianchi 1, 80131 Naples, Italy.
J Clin Med. 2020 Apr 13;9(4):1111. doi: 10.3390/jcm9041111.
Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy.
与依那普利的指南推荐剂量相比，沙库巴曲缬沙坦疗法可降低射血分数降低（HFrEF）患者的心源性猝死（SCD），但其机制仍不清楚。在扩张型心肌病（DCM）的临床背景下，关于沙库巴曲缬沙坦对心律失常的影响，存在一些相互矛盾的结果，且尚无关于其对可植入式心律转复除颤器（ICD）测量电参数（如心房/心室电图感知和起搏阈值）影响的临床数据。我们对167例缺血性和非缺血性DCM患者（平均年龄68.1±11.6岁；85%为男性）进行了一项为期12个月的随访观察研究，这些患者接受沙库巴曲缬沙坦治疗并植入双腔ICD，以评估设备检测到的房性和室性快速心律失常事件的发生率，以及测量的ICD电参数的变化。我们收集了临床、心电图和超声心动图参数的数据，以在结果中找到可能的机电相关性。我们的结果表明，接受沙库巴曲缬沙坦治疗且射血分数降低并植入ICD的DCM患者，房性和室性心律失常的发生率均有所降低，ICD心房电参数有所改善。这些发现可能是由沙库巴曲缬沙坦疗法引起的心脏机电逆向重塑所解释的。
