From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
ASAIO J. 2020 Aug;66(8):881-885. doi: 10.1097/MAT.0000000000001104.
Neurohormonal blockade (NHB) is the mainstay of therapy for patients with systolic heart failure (HF). However, the efficacy in patients with left ventricular assist devices (LVADs) remains unknown. Of all, 114 LVAD patients (57 [48, 65] years old and 78% male) were enrolled and followed during the early period (6 months after index discharge), and 98 were followed during the late period (6-12 months following index discharge). Of them, 46% were on beta-blocker (BB), 49% on angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin II receptor blocker (ARB), and 51% on aldosterone antagonist at baseline. Prevalence of BB and ACEi/ARB use increased during the study period. During the early period, similar event rates were found irrespective of the NHB uses. During the late period, BB was associated with reduced HF readmission, and ACEi/ARB was associated with reduced HF readmission and gastrointestinal bleeding (p < 0.05 for all). In conclusion, BB and ACEi/ARB use during the late period was associated with a reduction in HF recurrence in LVAD patients. Further prospective randomized control trials are warranted to clarify the utility of NHB therapy in LVAD patients.
神经激素阻断（NHB）是治疗收缩性心力衰竭（HF）患者的主要方法。然而，对于左心室辅助装置（LVAD）患者的疗效仍不清楚。共有 114 名 LVAD 患者（57[48,65]岁，78%为男性）在早期（指数出院后 6 个月）和 98 名患者在晚期（指数出院后 6-12 个月）期间接受了随访。其中，46%的患者使用了β受体阻滞剂（BB），49%的患者使用了血管紧张素转换酶抑制剂（ACEi）和/或血管紧张素 II 受体阻滞剂（ARB），51%的患者在基线时使用了醛固酮拮抗剂。在研究期间，BB 和 ACEi/ARB 的使用率均有所增加。在早期，无论 NHB 的使用情况如何，事件发生率相似。在晚期，BB 与 HF 再入院率降低相关，ACEi/ARB 与 HF 再入院率和胃肠道出血降低相关（所有 p 值均<0.05）。总之，LVAD 患者在晚期使用 BB 和 ACEi/ARB 与 HF 复发减少相关。需要进一步的前瞻性随机对照试验来阐明 NHB 治疗在 LVAD 患者中的应用价值。
