Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, George M. and Linda H. Kaufman Center for Heart Failure and Recovery, Cleveland Clinic, Cleveland, Ohio.
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
J Card Fail. 2021 Mar;27(3):368-372. doi: 10.1016/j.cardfail.2020.12.013. Epub 2021 Jan 16.
Prior study has demonstrated that transitioning patients in acutely decompensated heart failure with a low cardiac output directly from intravenous (i.v.) vasoactive (ie, vasodilators or inotropes) drugs to sacubitril-valsartan (S/V) can be done safely with tolerance to the 1-month follow-up. Here, we further characterize the hemodynamic impact of S/V after patients have been optimized on vasoactive therapy.
In a single-center, retrospective analysis, 25 patients with cardiac index of less than 2.2 L/min/m were admitted to the cardiac intensive care unit and newly initiated on angiotensin receptor-neprilysin inhibitor therapy with the guidance of invasive hemodynamic monitoring. Hemodynamic data were gathered and compared upon cardiac intensive care unit admission, after optimization with i.v. vasoactive therapy, and after S/V initiation and weaning off i.v.
All patients who tolerated S/V (n = 20) were weaned off vasoactive medications before transfer out of cardiac intensive care unit. Patients maintained their significant improvement in cardiac index and reduction in SVR/PVR on transition from i.v. inotropic and vasodilator therapy to oral S/V. There was an increase in pulmonary artery pulsatility index with S/V therapy compared with the i.v. vasoactive phase of care.
Patients in the cardiac intensive care unit can be successfully bridged from vasoactive i.v. therapy to oral S/V with sustained improvement in cardiac index garnered from vasoactive agents. We also observed improvement in the pulmonary artery pulsatility index and maintenance of left and right ventricular unloading with S/V. These encouraging findings merit further prospective study.
先前的研究表明，对于心输出量降低的急性失代偿性心力衰竭患者，直接将静脉（iv）血管活性（即血管扩张剂或正性肌力药）药物转换为 sacubitril-valsartan（S/V），可在耐受 1 个月随访的情况下安全进行。在此，我们进一步描述了患者在血管活性治疗优化后接受 S/V 治疗的血流动力学影响。
在一项单中心回顾性分析中，25 例心指数低于 2.2 L/min/m 的患者被收入心脏重症监护病房，并在有创血流动力学监测指导下开始使用血管紧张素受体-脑啡肽酶抑制剂治疗。在心脏重症监护病房入院时、优化静脉血管活性治疗后以及开始 S/V 并逐渐停用静脉治疗时收集并比较血流动力学数据。
所有耐受 S/V（n=20）的患者在转出心脏重症监护病房前均已停用血管活性药物。患者在从静脉正性肌力和血管扩张剂治疗过渡到口服 S/V 时，心指数显著改善，全身血管阻力/肺血管阻力降低。与静脉血管活性治疗阶段相比，S/V 治疗时肺动脉搏动指数增加。
可以成功地将接受静脉血管活性治疗的心脏重症监护病房患者过渡到口服 S/V，从血管活性药物中获得持续的心指数改善。我们还观察到 S/V 治疗时肺动脉搏动指数改善和左、右心室卸载维持。这些令人鼓舞的发现值得进一步的前瞻性研究。
