Hospital de Santa Marta, Lisboa - Portugal.
Arq Bras Cardiol. 2020 Nov;115(5):821-827. doi: 10.36660/abc.20190443.
Sacubitril/valsartan had its prognosis benefit confirmed in the PARADIGM-HF trial. However, data on cardiopulmonary exercise testing (CPET) changes with sacubitril-valsartan therapy are scarce.
This study aimed to compare CPET parameters before and after sacubitril-valsartan therapy.
Prospective evaluation of chronic heart failure (HF) patients with left ventricular ejection fraction ≤40% despite optimized standard of care therapy, who started sacubitril-valsartan therapy, expecting no additional HF treatment. CPET data were gathered in the week before and 6 months after sacubitril-valsartan therapy. Statistical differences with a p-value <0.05 were considered significant.
Out of 42 patients, 35 (83.3%) completed the 6-month follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years. New York Heart Association class improved in 26 (74.3%) patients. Maximal oxygen uptake (VO2max) (14.4 vs. 18.3 ml/kg/min, p<0.001), VE/VCO2slope (36.7 vs. 31.1, p<0.001), and exercise duration (487.8 vs. 640.3 sec, p<0.001) also improved with sacubitril-valsartan. Benefit was maintained even with the 24/26 mg dose (13.5 vs. 19.2 ml/kg/min, p=0.018) of sacubitril-valsartan, as long as this was the highest tolerated dose.
Sacubitril-valsartan therapy is associated with marked CPET improvement in VO2max, VE/VCO2slope, and exercise duration. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
沙库巴曲缬沙坦在 PARADIGM-HF 试验中已证实具有预后益处。然而，关于沙库巴曲缬沙坦治疗后心肺运动测试（CPET）变化的数据却很少。
本研究旨在比较沙库巴曲缬沙坦治疗前后 CPET 参数。
前瞻性评估左心室射血分数≤40%的慢性心力衰竭（HF）患者，这些患者尽管接受了最佳标准治疗，但仍开始使用沙库巴曲缬沙坦治疗，且不期望接受其他 HF 治疗。在开始沙库巴曲缬沙坦治疗前的一周和 6 个月时收集 CPET 数据。具有 p 值<0.05 的统计学差异被认为具有显著性。
42 例患者中，有 35 例（83.3%）完成了 6 个月的随访，因为有 2 例（4.8%）患者死亡，5 例（11.9%）因不良反应而停止治疗。患者平均年龄为 58.6±11.1 岁。26 例（74.3%）患者纽约心脏协会（NYHA）心功能分级改善。最大摄氧量（VO2max）（14.4 比 18.3 ml/kg/min，p<0.001）、VE/VCO2 斜率（36.7 比 31.1，p<0.001）和运动时间（487.8 比 640.3 秒，p<0.001）也随着沙库巴曲缬沙坦的应用而改善。只要沙库巴曲缬沙坦的剂量为 24/26mg（13.5 比 19.2 ml/kg/min，p=0.018），即为患者能耐受的最高剂量，这种获益就可以维持。
沙库巴曲缬沙坦治疗与 VO2max、VE/VCO2 斜率和运动时间的 CPET 显著改善相关。（Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0）。
