Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea.
Department of Pediatric Cardiology, Gachon University Gil Medical Center, Incheon, Korea.
Yonsei Med J. 2021 May;62(5):391-399. doi: 10.3349/ymj.2021.62.5.391.
Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients.
In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment.
One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, <0.001).
CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.
心力衰竭（HF）会导致严重的发病率和死亡率。最近，心室血管耦联指数（VVI）被引入，作为反映 HF 患者整体心血管表现指数的独立预后因素。我们旨在确定缬沙坦滴定剂量对 HF 患者 VVI 值的有效性。
在这项多中心前瞻性观察性试验中，根据左心室射血分数（LVEF）<55%的 HF 患者的剂量（非上限剂量（NCD）与上限剂量（CD））对缬沙坦的作用进行分层。在基线和治疗 24 周后评估生化研究，包括 N 端脑利钠肽前体（NT-proBNP）、VVI 超声心动图、跑步机测试和活动量表指数。
138 例患者被强制滴定至 CD 组（n=81）或 NCD 组（n=57）。研究参与者的平均年龄为 59 岁，66%为男性。6 个月随访后，CD 组的左心室质量指数（LVMI）值显著改善，但 NCD 组没有。有趣的是，在射血分数降低的心力衰竭（HFrEF）患者（n=52，LVEF<40%）中，仅在 CD 组观察到 VVI 显著改善（从 2.4±0.6 降至 1.8±0.5，<0.001）。
与 NCD 相比，缬沙坦的 CD 治疗 6 个月可显著改善 HFrEF 患者的 VVI 和 LVMI。
