沙库巴曲缬沙坦对冠心病合并慢性肾脏病的射血分数降低心力衰竭和中间射血分数心力衰竭患者临床症状、超声心动图参数及结局的影响。
Effects of sacubitril/valsartan on clinical symptoms, echocardiographic parameters, and outcomes in HFrEF and HFmrEF patients with coronary heart disease and chronic kidney disease.
机构信息
Cardiology Department, First Affiliated Hospital of Zhengzhou University, Henan, China.
出版信息
Curr Med Res Opin. 2021 Jul;37(7):1071-1078. doi: 10.1080/03007995.2021.1908243. Epub 2021 Apr 20.
OBJECTIVE
To compare the effects of Angiotensin Receptor-Neprilysin inhibitor (ARNI) on the clinical symptoms, echocardiographic parameters, and outcomes (cardiovascular death and hospitalization) in heart failure with reduced ejection fraction (HFrEF) and heart failure with mid-range ejection fraction (HFmrEF) patients with coronary heart disease and chronic kidney disease.
METHOD
A retrospective observational study was conducted from January 2018 to May 2019, with a follow-up period of 95.4 ± 57.8 days (8 months). Data from 127 patients were included.
RESULTS
A statistically significant increase of 68.8% was observed in left ventricular ejection fraction (LVEF) in HFrEF patients compared to that in HFmrEF patients, with an increase of 27.2% at 8 months of follow-up. Sacubitril/valsartan significantly reduced left ventricular end-systolic volumes (LVESV) in HFrEF patients unlike in HFmrEF patients. The decrease in LVESV was 28.8% in HFrEF patients and 17.1% in HFmrEF patients. A significant reduction in the prevalence of severe secondary mitral regurgitation (EROA > 0.4 cm) was observed in HFrEF compared to that in HFmrEF patients with the use of sacubitril/valsartan. A reduction of 15.6% was observed in HFrEF patients, whereas a reduction of 7.1% was observed in HFmrEF patients. Improvement in functional classification (NYHA) was observed during follow-up. The prevalence of (NYHA III) reduced from 50% to 15.7% in HFrEF patients, whereas a reduction from 21.1% to 8.8% was observed in HFmrEF patients. There was a significant reduction in NT-proBNP in HFrEF patients compared to that in HFmrEF patients. A reduction of 52% was observed in HFrEF patients, whereas a reduction of 28.7% was observed in HFmrEF pateints. Sacubitril/valsartan reduced primary endpoint events in both groups. The prevalence of HF-related hospitalization was higher in HFrEF than in HFmrEF patients: 12.1% vs 7.5%, respectively. The prevalence of CV death in HFrEF vs HFmrEF patients was 3.7% vs 0.5%, respectively. Cardiovascular (CV) death was higher in patients with atrial fibrillation in both groups.
CONCLUSION
Sacubitril/valsartan significantly improved morphofunctional remodeling parameters and clinical symptoms in HFrEF patients than in HFmrEF patients.
目的
比较血管紧张素受体-脑啡肽酶抑制剂（ARNI）对冠心病合并慢性肾脏病的射血分数降低的心力衰竭（HFrEF）和射血分数中间值的心力衰竭（HFmrEF）患者的临床症状、超声心动图参数和结局（心血管死亡和住院）的影响。
方法
这是一项回顾性观察性研究，于 2018 年 1 月至 2019 年 5 月进行，随访时间为 95.4±57.8 天（8 个月）。共纳入 127 例患者的数据。
结果
与 HFmrEF 患者相比，HFrEF 患者的左心室射血分数（LVEF）有统计学意义的增加了 68.8%，在 8 个月的随访中增加了 27.2%。与 HFmrEF 患者不同，沙库巴曲缬沙坦显著降低了 HFrEF 患者的左心室收缩末期容积（LVESV）。HFrEF 患者的 LVESV 降低了 28.8%，HFmrEF 患者降低了 17.1%。与 HFmrEF 患者相比，HFrEF 患者使用沙库巴曲缬沙坦后严重继发性二尖瓣反流（EROA＞0.4cm）的患病率显著降低。HFrEF 患者降低了 15.6%，而 HFmrEF 患者降低了 7.1%。在随访期间，心功能分级（NYHA）得到改善。HFrEF 患者（NYHA III）的患病率从 50%降至 15.7%，HFmrEF 患者从 21.1%降至 8.8%。与 HFmrEF 患者相比，HFrEF 患者的 NT-proBNP 显著降低。HFrEF 患者降低了 52%，而 HFmrEF 患者降低了 28.7%。沙库巴曲缬沙坦降低了两组的主要终点事件。HFrEF 患者因心力衰竭住院的发生率高于 HFmrEF 患者：分别为 12.1%和 7.5%。HFrEF 患者与 HFmrEF 患者的心血管（CV）死亡发生率分别为 3.7%和 0.5%。两组中房颤患者的 CV 死亡发生率更高。
结论
与 HFmrEF 患者相比，沙库巴曲缬沙坦显著改善了 HFrEF 患者的形态功能重塑参数和临床症状。
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