Pelaia Corrado, Armentaro Giuseppe, Volpentesta Mara, Mancuso Luana, Miceli Sofia, Caroleo Benedetto, Perticone Maria, Maio Raffaele, Arturi Franco, Imbalzano Egidio, Andreozzi Francesco, Perticone Francesco, Sesti Giorgio, Sciacqua Angela
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Front Cardiovasc Med. 2022 Apr 5;9:861663. doi: 10.3389/fcvm.2022.861663. eCollection 2022.
Heart failure with reduced ejection fraction (HFrEF) is a clinical condition frequently diagnosed in clinical practice. In patients affected by HFrEF, sleep apnea (SA) can be detected among the most frequent comorbidities. Sacubitril-valsartan (sac/val) association has been proven to be effective in reducing disease progression and all-cause mortality in HFrEF patients. Sac/val treatment can potentially attenuate SA development several pathophysiologic mechanisms, including improvement of global hemodynamics, reduction of extracellular fluid overload, and decrease of sympathetic neural activity.
We recruited 132 patients affected by HFrEF and SA, already under treatment with continuous positive airway pressure (CPAP), which was discontinued 24 h before the scheduled study timepoints. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient at baseline and after a 6-month treatment with sac/val.
After 6 months, sac/val induced statistically significant changes in clinical, hemodynamic, biohumoral (NT-proBNP, serum electrolytes, creatinine, and uric acid), and echocardiographic parameters. In particular, cardiac index (CI), both atrial and ventricular volumes and global longitudinal strain (GLS) improved. Moreover, polysomnography, carried out during a temporary CPAP interruption, revealed a significant reduction in global apnea-hypopnea index (AHI) value ( < 0.0001), central AHI ( < 0.0001), obstructive AHI ( < 0.0001), oxygen desaturation index (ODI) ( < 0.0001), and percentage time of saturation below 90% (TC90) ( < 0.0001). The changes of CI, estimated glomerular filtration rate (eGFR), NT-proBNP, and tricuspid annular plane excursion (TAPSE) contributed to 23.6, 7.6, 7.3, and 4.8% of AHI variability, respectively, and the whole model accounted for a 43.3% of AHI variation.
Our results suggest that treatment with sac/val is able to significantly improve the cardiorespiratory performance of patients with HFrEF and SA, integrating the positive impact of CPAP. Thus, both CPAP and sac/val therapy may synergistically contribute to lower the risks of both cardiac and pulmonary complications in HFrEF patients with SA.
射血分数降低的心力衰竭（HFrEF）是临床实践中经常诊断出的一种临床病症。在受HFrEF影响的患者中，睡眠呼吸暂停（SA）是最常见的合并症之一。沙库巴曲缬沙坦（sac/val）联合用药已被证明可有效降低HFrEF患者的疾病进展和全因死亡率。Sac/val治疗可能通过多种病理生理机制减轻SA的发生，包括改善整体血流动力学、减少细胞外液超负荷以及降低交感神经活动。
我们招募了132例受HFrEF和SA影响且已接受持续气道正压通气（CPAP）治疗的患者，在预定研究时间点前24小时停用CPAP。在基线时以及接受sac/val治疗6个月后，对每位患者进行体格检查、超声心动图检查、夜间心肺监测和实验室检查。
6个月后，sac/val在临床、血流动力学、生物体液（NT-脑钠肽、血清电解质、肌酐和尿酸）和超声心动图参数方面引起了具有统计学意义的变化。特别是，心脏指数（CI）、心房和心室容积以及整体纵向应变（GLS）均有所改善。此外，在临时中断CPAP期间进行的多导睡眠图显示，整体呼吸暂停低通气指数（AHI）值（<0.0001）、中枢性AHI（<0.0001）、阻塞性AHI（<0.0001）、氧饱和度下降指数（ODI）（<0.0001）以及饱和度低于90%的时间百分比（TC90）（<0.0001）均显著降低。CI、估计肾小球滤过率（eGFR）、NT-脑钠肽和三尖瓣环平面位移（TAPSE）的变化分别占AHI变异性的23.6%、7.6%、7.3%和4.8%，整个模型占AHI变化的43.3%。
我们的结果表明，sac/val治疗能够显著改善HFrEF和SA患者的心肺功能，增强CPAP的积极影响。因此，CPAP和sac/val治疗可能协同作用，降低伴有SA的HFrEF患者发生心脏和肺部并发症的风险。
