Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar, 66421, Germany.
Department of Medicine, Cardiology, Goethe University Hospital, Frankfurt, Frankfurt am Main, Germany.
ESC Heart Fail. 2022 Feb;9(1):155-163. doi: 10.1002/ehf2.13665. Epub 2021 Nov 4.
Control of pulmonary pressures monitored remotely reduced heart failure hospitalizations mainly by lowering filling pressures through the use of loop diuretics. Sacubitril/valsartan improves heart failure outcomes and increases the kidney sensitivity for diuretics. We explored whether sacubitril/valsartan is associated with less utilization of loop diuretics in patients guided with haemodynamic monitoring in the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF).
The MEMS-HF population (n = 239) was separated by the use of sacubitril/valsartan (n = 68) or no use of it (n = 164). Utilization of diuretics and their doses was prespecified in the protocol and was monitored in both groups. Multivariable regression, ANCOVA, and a generalized linear model were used to fit baseline covariates with furosemide equivalents and changes for 12 months. MEMS-HF participants (n = 239) were grouped in sacubitril/valsartan users [n = 68, 64 ± 11 years, left ventricular ejection fraction (LVEF) 25 ± 9%, cardiac index (CI) 1.89 ± 0.4 L/min/m ] vs. non-users (n = 164, 70 ± 10 years, LVEF 36 ± 16%, CI 2.11 ± 0.58 L/min/m , P = 0.0002, P < 0.0001, and P = 0.0015, respectively). In contrast, mean pulmonary artery pressure (PAP) values were comparable between groups (29 ± 11 vs. 31 ± 11 mmHg, P = 0.127). Utilization of loop diuretics was lower in patients taking sacubitril/valsartan compared with those without (P = 0.01). Significant predictor of loop diuretic use was a history of renal failure (P = 0.005) but not age (P = 0.091). After subjects were stratified by sacubitril/valsartan or other diuretic use, PAP was nominally, but not significantly lower in sacubitril/valsartan-treated patients (baseline: P = 0.52; 6 months: P = 0.07; 12 months: P = 0.53), while there was no difference in outcome or PAP changes. This difference was observed despite lower CI (P = 0.0015). Comparable changes were not observed for other non-loop diuretics (P = 0.21).
In patients whose treatment was guided by remote PAP monitoring, concomitant use of sacubitril/valsartan was associated with reduced utilization of loop diuretics, which could potentially be relevant for outcomes.
通过使用袢利尿剂降低充盈压，远程监测肺压控制可显著减少心力衰竭住院次数。沙库巴曲缬沙坦可改善心力衰竭的预后，并提高利尿剂对肾脏的敏感性。我们探讨了在心脏磁敏感监测心力衰竭的欧洲监测研究（MEMS-HF）中，使用血流动力学监测指导下的患者中，沙库巴曲缬沙坦是否与较少使用袢利尿剂有关。
MEMS-HF 人群（n=239）根据是否使用沙库巴曲缬沙坦（n=68）或未使用（n=164）分为两组。在方案中预设了利尿剂的使用和剂量，并在两组中进行监测。多变量回归、ANCOVA 和广义线性模型用于拟合基线协变量与呋塞米等效物和 12 个月的变化。MEMS-HF 参与者（n=239）分为沙库巴曲缬沙坦使用者[68 人，64±11 岁，左心室射血分数（LVEF）25±9%，心指数（CI）1.89±0.4 L/min/m]与非使用者（n=164，70±10 岁，LVEF 36±16%，CI 2.11±0.58 L/min/m，P=0.0002，P<0.0001，P=0.0015）。相比之下，两组的平均肺动脉压（PAP）值相似（29±11 vs. 31±11mmHg，P=0.127）。与未使用者相比，服用沙库巴曲缬沙坦的患者利尿剂使用率较低（P=0.01）。利尿剂使用的显著预测因素是肾衰竭史（P=0.005），而不是年龄（P=0.091）。在根据沙库巴曲缬沙坦或其他利尿剂使用对患者进行分层后，沙库巴曲缬沙坦治疗组的 PAP 略有但无统计学意义降低（基线：P=0.52；6 个月：P=0.07；12 个月：P=0.53），而结局或 PAP 变化无差异。这一差异是在较低的 CI（P=0.0015）下观察到的。对于其他非袢利尿剂，未观察到类似的变化（P=0.21）。
在接受远程 PAP 监测指导治疗的患者中，同时使用沙库巴曲缬沙坦与降低袢利尿剂的使用相关，这可能与结局相关。
