Department of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2022 May 3;11(9):e024449. doi: 10.1161/JAHA.121.024449. Epub 2022 Apr 26.
Background Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta-analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension. Methods and Results We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle-Ottawa scale. Variables were pooled using a random-effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33-2.18 mm; =0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25-1.45 cm/s; =0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38-9.03 mm Hg; <0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data (=0.026). Conclusions This meta-analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021247970.
沙库比曲缬沙坦（S/V）在改善射血分数降低的心力衰竭患者的左心室功能和重塑方面显示出显著效果。然而，其对右心室的影响尚不清楚。本系统评价和荟萃分析旨在评估 S/V 对右心室功能和肺动脉高压的影响。
我们从 2010 年 1 月至 2021 年 4 月在 PubMed、Embase、Cochrane 图书馆和 Web of Science 中搜索了报告 S/V 治疗后右心室和肺压指标的研究。使用纽卡斯尔-渥太华量表评估纳入研究的质量。使用随机效应模型汇总变量，以估计加权均数差值及其 95%置信区间。我们确定了 10 项符合条件的研究，共纳入 875 例射血分数降低的心力衰竭患者（平均年龄 62.2 岁，74.0%为男性），均为观察性研究。S/V 起始后右心室功能和肺动脉高压显著改善，包括三尖瓣环平面收缩期位移（加权均数差值，1.26mm；95%CI，0.33-2.18mm；=0.008）、三尖瓣环收缩期峰值速度（加权均数差值，0.85cm/s；95%CI，0.25-1.45cm/s；=0.005）和收缩期肺动脉压（加权均数差值，7.21mmHg；95%CI，5.38-9.03mmHg；<0.001）。此外，S/V 对左心功能也有显著的有益影响，这与之前的研究一致。排除不恰当数据后，二次回归模型显示三尖瓣环平面收缩期位移与左心室射血分数之间存在一定相关性（=0.026）。
本荟萃分析证实 S/V 可改善射血分数降低的心力衰竭患者的右心室功能和肺动脉高压，且似乎不完全依赖于左心室的逆重构。
