Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Int J Cardiol. 2021 Mar 15;327:138-145. doi: 10.1016/j.ijcard.2020.11.071. Epub 2020 Dec 8.
Current international guidelines recommend switching angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARBs) to sacubitril/valsartan (S/V) in stable outpatients affected by heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite being on optimal medical therapy. Since these guidelines were published, new data may support further clinical applications and benefits of S/V beyond ambulatory HFrEF patients. The efficacy of S/V seems to be consistent across a wider array of subgroups including age, sex, etiology of HF, comorbidities, EF and estimated cardiovascular risk, with safety and tolerability profiles similar to ACE-I and ARBs. Additional clinical trial data are required to confirm the potential benefits of S/V in patients with mid-range or preserved EF, as suggested by analysis of PARAGON-HF, or in combination with sodium-glucose co-transporter 2 inhibitors or in post-myocardial infarction HF. In this article we summarize the new evidence on the effects and safety profile of S/V in HF and discuss current perspectives and persisting gaps. Currently, available evidence may support S/V as a first-line therapy in outpatient or in-hospital HFrEF patients, and possibly also in HFmrEF patients.
目前的国际指南建议，对于射血分数降低的心力衰竭（HFrEF）且稳定的门诊患者，如果尽管接受了最佳药物治疗仍有症状，可将血管紧张素转换酶抑制剂（ACE-i）或血管紧张素受体阻滞剂（ARBs）转换为沙库巴曲缬沙坦（S/V）。自这些指南发布以来，新的数据可能支持 S/V 在除了 HFrEF 门诊患者之外的其他临床应用和获益。S/V 的疗效似乎在更广泛的亚组中保持一致，包括年龄、性别、HF 的病因、合并症、EF 和估计的心血管风险，其安全性和耐受性与 ACE-i 和 ARBs 相似。需要额外的临床试验数据来确认 S/V 在射血分数中间值或保留的 HF 患者中的潜在获益，正如 PARAGON-HF 的分析所表明的，或与钠-葡萄糖共转运蛋白 2 抑制剂联合使用，或在心肌梗死后 HF 中。本文总结了 S/V 在 HF 中的作用和安全性方面的新证据，并讨论了当前的观点和持续存在的差距。目前，现有证据可能支持 S/V 作为 HFrEF 门诊或住院患者的一线治疗药物，也可能适用于 HFmrEF 患者。
