Cardiology Department, First Affiliated Hospital of Zhengzhou University, Henan, China.
Curr Med Res Opin. 2021 Jul;37(7):1071-1078. doi: 10.1080/03007995.2021.1908243. Epub 2021 Apr 20.
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.
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.
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.
Sacubitril/valsartan significantly improved morphofunctional remodeling parameters and clinical symptoms in HFrEF patients than in HFmrEF patients.
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。
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。
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。
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。
