Istituto Auxologico Italiano IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, Ospedale S. Luca.
Dipartimento di Medicina e Chirurgia, Università di Milano-Bicocca, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2020 Sep;21(9):682-687. doi: 10.2459/JCM.0000000000001000.
The angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) is recommended for the treatment of patients with heart failure in New York Heart Association (NYHA) class II-III and left ventricular ejection fraction (LVEF) 35% or less. We examined the effects of sacubitril/valsartan on cardiac remodeling and their correlation with heart failure duration in patients enrolled in our heart failure clinic from March 2017 to December 2019.
Echocardiographic and clinical/laboratory data were collected at baseline and at 6-month and 12-month follow-up visits in 69 patients (age 67 ± 12 years, disease duration 8.4 ± 5.8 years, 93% men).
At both time points, mean NYHA class, NT-proBNP level, LVEF, LV end-systolic volume, and estimated systolic pulmonary pressure significantly (P < 0.05) improved versus baseline, as did the proportion of patients with diastolic dysfunction grade 3 or functional mitral regurgitation grade 3-4. In the subgroup with mean disease duration less than 8.5 years (n = 40), there was a significant improvement in all variables at both time points; in this group, a recovery of right ventricular function was also seen at the 12-month follow-up. On the contrary, patients with heart failure duration of at least 8.5 years (n = 29) showed only a slight improvement in LVEF and mitral regurgitation at 12 months. There were no significant changes in renal function and/or potassium levels in all patients.
In patients with a relatively short disease duration, sacubitril/valsartan was associated with a strong favorable remodeling of the left ventricle and improvement in pulmonary circulation.
血管紧张素受体和脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦（LCZ696）推荐用于治疗纽约心脏协会（NYHA）心功能分级 II-III 级和左心室射血分数（LVEF）35%或更低的心力衰竭患者。我们研究了沙库巴曲缬沙坦对心脏重构的影响及其与心力衰竭病程的相关性，研究对象为 2017 年 3 月至 2019 年 12 月期间在我院心力衰竭门诊就诊的 69 例患者（年龄 67±12 岁，病程 8.4±5.8 年，93%为男性）。
收集 69 例患者的超声心动图和临床/实验室数据，分别于基线、6 个月和 12 个月随访时进行。
与基线相比，在这两个时间点，NYHA 心功能分级、NT-proBNP 水平、LVEF、左心室收缩末期容积和估计收缩期肺动脉压均显著（P<0.05）改善，舒张功能 3 级或功能性二尖瓣反流 3-4 级的患者比例也增加。在平均病程小于 8.5 年的亚组（n=40）中，所有变量在两个时间点均有显著改善；在该组中，右心室功能也在 12 个月随访时得到恢复。相反，心力衰竭病程至少 8.5 年的患者（n=29）仅在 12 个月时 LVEF 和二尖瓣反流有轻微改善。所有患者的肾功能和/或血钾水平均无明显变化。
在病程相对较短的患者中，沙库巴曲缬沙坦可显著改善左心室重构和肺循环。
