沙库巴曲缬沙坦在降低晚期心力衰竭患者抑郁中的作用。
Effect of Sacubitril-Valsartan in reducing depression in patients with advanced heart failure.
机构信息
Federico II" University of Naples, Department of Translational Medical Sciences, 80131 Naples, Italy; Monaldi Hospital, Azienda dei Colli, Department of Cardiovascular Surgery and Transplant, 80131, Naples, Italy.
Monaldi Hospital, Azienda dei Colli, Department of Cardiovascular Surgery and Transplant, 80131, Naples, Italy.
出版信息
J Affect Disord. 2020 Jul 1;272:132-137. doi: 10.1016/j.jad.2020.03.158. Epub 2020 Apr 30.
BACKGROUND
Depression is highly prevalent in Heart Failure (HF). Treatment with sacubitril/valsartan improved quality of life and survival in HF patients. Aim of the study was to investigate prospectively the effect of sacubitril/valsartan on depression in advanced HF patients in waiting list for heart transplant (HT).
METHODS
37 consecutive patients with advanced HF in waiting list for HT were treated with sacubitril/valsartan. We analyzed data derived from the assessment performed the year before the beginning of sacubitril/valsartan, at study entry, and at one year of follow-up. Depression was assessed with Beck Depression Inventory II (BDI) scale. Cognitive function were assessed with Mini-Mental State Examination (MMSE). Functioning was evaluated measuring meters at 6 Minute Walking Test (6MWT) and maximum rate of oxygen consumption (VO max).
RESULTS
At baseline, 64.9% of HF patients were in NYHA III and 35.1% NYHA IIIB, BDI was 15.2 ± 5.2 with 59.5% of patients with a score > 13. MMSE was 27.8 ± 2.6. After one year of follow-up NYHA class improved significantly, with 56.8% in NYHA II, 40.5% in NYHA III and 2.7% NYHA in IIIB (p < 0.001). VO max and 6MWT increased. Notably, BDI was 9.5 ± 3.9 with 21.6% of patients with a score > 13. MMSE remain stable (28.2 ± 2.1) (p = 0.104). No statistical differences are observed between data collected in the evaluation 1-year before and soon before treatment with sacubitril/valsartan. Multivariate regression analysis demonstrate a relationship between reduction in BDI-II score and improvement in six-minute walking test independently by the effect of sex, age, selective serotonin reuptake inhibitors, VO max, NT-proBNP, PAPs, NYHA class differences evaluated at follow-up versus baseline.
CONCLUSIONS
Our study showed a reduction in depressive symptomatology in heart transplant waiting list patients treated with sacubitril/valsartan. The improvement in depressive symptomatology was paralleled by 6MWT increase in the follow-up.
背景
心力衰竭（HF）患者中抑郁症的发病率很高。沙库巴曲缬沙坦治疗可改善 HF 患者的生活质量和生存率。本研究旨在前瞻性研究沙库巴曲缬沙坦对等待心脏移植（HT）的晚期 HF 患者的抑郁的影响。
方法
37 例等待 HT 的晚期 HF 患者接受沙库巴曲缬沙坦治疗。我们分析了在开始沙库巴曲缬沙坦治疗前一年、研究入组时和一年随访时获得的数据。采用贝克抑郁自评量表（BDI）评估抑郁。采用简易精神状态检查（MMSE）评估认知功能。采用 6 分钟步行试验（6MWT）和最大耗氧量（VO max）评估米尺。
结果
基线时，64.9%的 HF 患者为 NYHA III 级，35.1%为 NYHA IIIB 级，BDI 为 15.2±5.2，59.5%的患者评分>13。MMSE 为 27.8±2.6。一年随访后，NYHA 分级显著改善，NYHA II 级 56.8%，NYHA III 级 40.5%，NYHA IIIB 级 2.7%（p<0.001）。VO max 和 6MWT 增加。值得注意的是，BDI 为 9.5±3.9，21.6%的患者评分>13。MMSE 保持稳定（28.2±2.1）（p=0.104）。在沙库巴曲缬沙坦治疗前 1 年和治疗前收集的数据之间未观察到统计学差异。多变量回归分析显示，BDI-II 评分的降低与 6 分钟步行试验的改善之间存在关系，而这种关系不受性别、年龄、选择性 5-羟色胺再摄取抑制剂、VO max、NT-proBNP、PAPs、随访时与基线时 NYHA 分级差异的影响。
结论
我们的研究显示，在接受沙库巴曲缬沙坦治疗的等待心脏移植的患者中，抑郁症状有所减轻。在随访中，6MWT 的增加与抑郁症状的改善相平行。
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