沙库巴曲缬沙坦治疗伴或不伴糖尿病的心力衰竭患者后的心脏逆重构。
Reverse Cardiac Remodeling Following Initiation of Sacubitril/Valsartan in Patients With Heart Failure With and Without Diabetes.
机构信息
University of Mississippi, Jackson, Mississippi, USA.
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA.
出版信息
JACC Heart Fail. 2021 Feb;9(2):137-145. doi: 10.1016/j.jchf.2020.09.014. Epub 2020 Dec 9.
OBJECTIVE
This study sought to determine whether patients with heart failure and reduced ejection fraction (HFrEF) with type 2 diabetes mellitus (T2DM) have similar reverse cardiac remodeling with sacubitril/valsartan as patients without T2DM.
BACKGROUND
Sacubitril/valsartan promotes reverse cardiac remodeling and improves outcomes in patients with HFrEF. Patients with HFrEF with T2DM have worse prognosis than those without T2DM.
METHODS
In this post hoc analysis of PROVE-HF (Prospective Study of Biomarkers, Symptom Improvement, and Ventricular Remodeling During Sacubitril/Valsartan Therapy for Heart Failure), we examined changes in N-terminal pro-b-type natriuretic peptide (NT-proBNP), measures of cardiac remodeling, and Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) scores from baseline to 12 months following initiation of sacubitril/valsartan between patients with HFrEF with and without T2DM. Using latent growth curve modeling, we evaluated the longitudinal association between changes in NT-proBNP, left ventricular ejection fraction, and KCCQ-OS.
RESULTS
Among 794 patients enrolled, 361 (45.5%) had T2DM. NT-proBNP concentrations were modestly higher at baseline among patients with T2DM but were reduced after initiation of sacubitril/valsartan. Cross-sectional improvement was observed in left ventricular ejection fraction (T2DM: 28.3% at baseline and 37% at 12 months vs. non-T2DM: 28.1% at baseline and 38.3% at 12 months) and KCCQ-OS (T2DM: 71 at baseline and 83 at 12 months vs. non-T2DM: 76 at baseline and 88 at 12 months). Similar changes were also observed for other echocardiographic measures. In longitudinal analyses, the average NT-proBNP change was similar in patients with T2DM (-5.6% vs. -7.1% per 90-day interval; p = 0.64), whereas improvements in KCCQ-OS scores were slightly smaller (2.1 vs. 3.46 per 90-day interval; p = 0.07).
CONCLUSIONS
Sacubitril/valsartan favorably affects natriuretic peptide levels, reverse cardiac remodeling, and health status in patients with HFrEF with and without T2DM. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183).
目的
本研究旨在确定患有 2 型糖尿病（T2DM）的射血分数降低的心力衰竭（HFrEF）患者与无 T2DM 患者相比，是否具有类似的逆转心肌重构作用。
背景
沙库巴曲缬沙坦可促进 HFrEF 患者的心肌重构逆转，并改善其预后。患有 T2DM 的 HFrEF 患者的预后比无 T2DM 的患者更差。
方法
在 PROVE-HF（沙库巴曲缬沙坦治疗心力衰竭的生物标志物、症状改善和心室重构的前瞻性研究）的这项事后分析中，我们比较了基线时和沙库巴曲缬沙坦治疗 12 个月时，HFrEF 合并和不合并 T2DM 患者的 N 末端 pro-B 型利钠肽（NT-proBNP）、心脏重构指标和堪萨斯城心肌病问卷整体评分（KCCQ-OS）的变化。我们采用潜在增长曲线模型评估了 NT-proBNP、左心室射血分数和 KCCQ-OS 变化之间的纵向相关性。
结果
在纳入的 794 名患者中，有 361 名（45.5%）患有 T2DM。T2DM 患者的基线 NT-proBNP 浓度略高，但在开始沙库巴曲缬沙坦治疗后降低。左心室射血分数（T2DM：基线时为 28.3%，12 个月时为 37%，非 T2DM：基线时为 28.1%，12 个月时为 38.3%）和 KCCQ-OS（T2DM：基线时为 71，12 个月时为 83，非 T2DM：基线时为 76，12 个月时为 88）在横截面上均有改善。其他超声心动图指标也观察到类似的变化。在纵向分析中，T2DM 患者的平均 NT-proBNP 变化相似（每 90 天间隔降低 5.6% vs. -7.1%；p=0.64），而 KCCQ-OS 评分的改善则略小（每 90 天间隔提高 2.1 vs. 3.46；p=0.07）。
结论
沙库巴曲缬沙坦可改善 HFrEF 合并和不合并 T2DM 患者的利钠肽水平、逆转心肌重构和健康状况。（沙库巴曲缬沙坦治疗对生物标志物、心肌重构和结局的影响[PROVE-HF]；NCT02887183）。
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