Moliner-Abós Carles, Mojón Álvarez Diana, Rivas-Lasarte Mercedes, Belarte Laia Carla, Pamies Besora Julia, Solé-González Eduard, Fluvià-Brugues Paula, Zegrí-Reiriz Isabel, López López Laura, Brossa Vicens, Pirla Maria José, Mesado Nuria, Mirabet Sonia, Roig Eulàlia, Álvarez-García Jesús
Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBERCV, Universidad Autónoma de Barcelona, Barcelona, Spain.
Cardiology Department, Hospital del Mar, Barcelona, Spain.
Front Physiol. 2021 Feb 18;12:642117. doi: 10.3389/fphys.2021.642117. eCollection 2021.
Sacubitril/valsartan (SV) promotes cardiac remodeling and improves prognosis in patients with heart failure (HF). However, the response to the drug may vary between patients and its implementation in daily clinical practice has been slower than expected. Our objective was to develop a score predicting the super-response to SV in HF outpatients.
This is a retrospective analysis of 185 consecutive patients prescribed SV from two tertiary hospitals between September 2016 and February 2018. Super-responder was defined as a patient taking the drug and (i) without HF admissions, death, or heart transplant, and (ii) with a ≥50% reduction in NT-proBNP levels and/or an increase of ≥10 points in LVEF in a 12-month follow-up period after starting SV. Clinical, echocardiographic, ECG, and biochemical variables were used in a logistic regression analysis to construct a score for super-response to SV which was internally validated using bootstrap method.
Out of 185 patients, 65 (35%) fulfilled the super-responder criteria. Predictors for super-response to SV were absence of both previous aldosterone antagonist and diuretic treatment, NYHA I-II class, female gender, previous 1-year HF admission, and sinus rhythm. An integrating score distinguished a low- (<25%), intermediate- (∼46%), and high-probability (>80%) for 1-year super-response to SV. The AUC for the model was 0.72 (95%CI: 0.64-0.80), remaining consistent after internal validation.
One-third of our patients presented a super-response to SV. We propose an easy-to-calculate score to predict super-response to SV after 1-year initiation based on variables that are currently assessed in clinical practice.
沙库巴曲缬沙坦（SV）可促进心脏重塑并改善心力衰竭（HF）患者的预后。然而，患者对该药物的反应可能存在差异，并且其在日常临床实践中的应用进展比预期要慢。我们的目标是开发一种评分系统，用于预测HF门诊患者对SV的超反应。
这是一项对2016年9月至2018年2月期间两家三级医院连续185例接受SV治疗患者的回顾性分析。超反应者定义为服用该药物且（i）在开始服用SV后的12个月随访期内未发生HF住院、死亡或心脏移植，以及（ii）NT-proBNP水平降低≥50%和/或左心室射血分数（LVEF）增加≥10分的患者。临床、超声心动图、心电图和生化变量用于逻辑回归分析，以构建对SV超反应的评分系统，并使用自助法进行内部验证。
185例患者中，65例（35%）符合超反应者标准。对SV超反应的预测因素为既往未使用醛固酮拮抗剂和利尿剂治疗、纽约心脏协会（NYHA）心功能I-II级、女性、既往1年HF住院以及窦性心律。一个综合评分可区分出1年对SV超反应的低概率（<25%）、中概率（~46%）和高概率（>80%）。该模型的曲线下面积（AUC）为0.72（95%置信区间：0.64-0.80），内部验证后保持一致。
我们的患者中有三分之一对SV呈现超反应。我们基于目前临床实践中评估的变量，提出了一种易于计算的评分系统，用于预测开始服用SV 1年后的超反应。
