Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Gastroenterology, The Chongqing Traditional Chinese Medicine Hospital, Chongqing Academy of Traditional Chinese Medicine, Chongqing, China.
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Heart Lung Circ. 2021 May;30(5):683-691. doi: 10.1016/j.hlc.2020.10.012. Epub 2020 Nov 13.
The effect of sacubitril-valsartan in heart failure patients with mid-range (HFmEF) and preserved (HFpEF) ejection fractions remains unclear. This study aimed to investigate the clinical benefits of sacubitril-valsartan in HFmEF and HFpEF patients.
PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure were searched from inception to 29 February 2020 to identify pertinent articles. Studies meeting the inclusion criteria were included and analysed.
Six (6) studies, with a total of 5,503 patients, were included. Compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, sacubitril-valsartan significantly reduced the rate of HF hospitalisation (risk ratios, 0.84; 95% CI, 0.77-0.91; p<0.001) and improved the New York Heart Association class (risk ratios, 1.25; 95% CI, 1.10-1.43; p=0.001) in HFmEF and HFpEF patients. Both the cardiovascular mortality and all-cause mortality were not significantly decreased by sacubitril-valsartan. In addition, there were no significant between-group differences in the N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction changes. Regarding safety, sacubitril-valsartan was likely to increase the risk of hypotension, but the incidence of serum creatinine elevation was significantly lower in the sacubitril-valsartan group than in the angiotensin-converting enzyme inhibitors and angiotensin receptor blockers group.
This meta-analysis suggests that sacubitril-valsartan may be an effective and safe strategy with which to improve the clinical symptoms and reduce HF hospitalisation in HFmEF and HFpEF patients.
沙库巴曲缬沙坦在射血分数中间值（HFmEF）和射血分数保留（HFpEF）心力衰竭患者中的作用尚不清楚。本研究旨在探讨沙库巴曲缬沙坦在 HFmEF 和 HFpEF 患者中的临床获益。
从建库至 2020 年 2 月 29 日，我们检索了 PubMed、EMBASE、Cochrane 图书馆和中国知网，以确定相关文章。纳入符合纳入标准的研究并进行分析。
纳入 6 项（共 5503 例患者）研究。与血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂相比，沙库巴曲缬沙坦可显著降低 HF 住院率（风险比，0.84；95%置信区间，0.77-0.91；p<0.001）和改善纽约心脏协会心功能分级（风险比，1.25；95%置信区间，1.10-1.43；p=0.001）。沙库巴曲缬沙坦并不能显著降低心血管死亡率和全因死亡率。此外，两组间 N 末端脑钠肽前体和左心室射血分数的变化无显著差异。关于安全性，沙库巴曲缬沙坦可能增加低血压风险，但沙库巴曲缬沙坦组的血肌酐升高发生率显著低于血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂组。
本荟萃分析表明，沙库巴曲缬沙坦可能是一种有效且安全的策略，可改善 HFmEF 和 HFpEF 患者的临床症状并降低 HF 住院率。
