Alishetti Shudhanshu, Braghieri Lorenzo, Jennings Douglas L, Uriel Nir, Colombo Paolo C, Yuzefpolskaya Melana
Division of Cardiology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA.
Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA.
Int J Artif Organs. 2022 Jan;45(1):118-120. doi: 10.1177/0391398821989066. Epub 2021 Jan 19.
Though left ventricular assist devices (LVADs) are an increasingly common therapy for ACC/AHA Stage D heart failure, the optimal medical therapy for patients with LVADs is not known. We sought to evaluate the safety and efficacy of angiotensin receptor neprilysin inhibitor (ARNi) therapy in our single center LVAD patient experience. We evaluated patients implanted with LVADs at Columbia University Irving Medical Center between August 2010 and May 2019, and who were treated with an ARNi for at least 3 months. Thirty patients met this criteria. Eighteen (60%) patients transitioned to an ARNi from an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), while all were on a beta blocker (BB) at the time of ARNi initiation. The primary outcome, NT-proBNP levels at time of initiation and 3 and 6 month follow up, significantly decreased from a median of 1265 pg/mL at initiation to 750 pg/mL at 3 months and 764 pg/mL at 6 months ( = 0.01). No significant change was seen in serum creatinine, BUN, or potassium levels.
尽管左心室辅助装置（LVADs）越来越成为美国心脏病学会/美国心脏协会D期心力衰竭的常用治疗方法，但LVAD患者的最佳药物治疗方案尚不清楚。我们试图在我们单中心LVAD患者的经验中评估血管紧张素受体脑啡肽酶抑制剂（ARNi）治疗的安全性和有效性。我们评估了2010年8月至2019年5月在哥伦比亚大学欧文医学中心植入LVADs并接受ARNi治疗至少3个月的患者。30名患者符合该标准。18名（60%）患者从血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）转换为ARNi，而所有患者在开始使用ARNi时均服用β受体阻滞剂（BB）。主要结局指标，即开始治疗时、3个月和6个月随访时的NT-proBNP水平，从开始时的中位数1265 pg/mL显著降至3个月时的750 pg/mL和6个月时的764 pg/mL（P = 0.01）。血清肌酐、尿素氮或钾水平未见显著变化。
