沙库巴曲缬沙坦对持续性心房颤动患者窦性心律恢复及维持的影响
Effect of Sacubitril-Valsartan on Restoration and Maintenance of Sinus Rhythm in Patients With Persistent Atrial Fibrillation.
作者信息
Chen Qingsong, Chen Yunlin, Qin Fang, Du Huaan, Gan Chunxia, Zhou Bei, Wang Na, Xiao Mingyang, Ou Zhenhong, Zhao Wei, Cui Ben, Liu Zengzhang, Yin Yuehui
机构信息
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Cardiovasc Med. 2022 May 30;9:870203. doi: 10.3389/fcvm.2022.870203. eCollection 2022.
BACKGROUND
Existing studies have shown that sacubitril-valsartan ameliorated atrial remodeling in atrial fibrillation (AF) and favored maintenance of sinus rhythm in patients with AF and heart failure. However, the effect of sacubitril-valsartan in patients with persistent AF is yet unknown. We aimed to evaluate the effect of sacubitril-valsartan on restoration and maintenance of sinus rhythm in patients with persistent AF who underwent electrical cardioversion (ECV).
METHOD
Consecutive patients with persistent AF who underwent ECV between 1 January 2016 and 30 September 2020 were investigated in this retrospective cohort study. All eligible patients were categorized into sacubitril-valsartan users and sacubitril-valsartan non-users based on whether they received treatment with sacubitril-valsartan or not. The endpoint was ineffictive ECV, defined as the composite of failure to terminate AF or any recurrence of AF during 30 days follow-up.
RESULTS
A total of 76 patients were enrolled in this study, including 28 sacubitril-valsartan users and 48 non-users. Within a follow-up of 30 days after ECV, the endpoint had occurred in 7 (25%) of 28 sacubitril-valsartan users and 25 (52%) of 48 non-users. Significantly lower rate of ineffictive ECV in sacubitril-valsartan users compared with non-users was shown in Kaplan-Meier survival curves ( = 0.02; Log-rank test). Multivariate Cox regression analysis indicated that sacubitril-valsartan use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14-0.91), amiodarone use (HR, 0.32; 95% CI, 0.13-0.78), left atrial diameter ≤ 39 mm (HR, 0.21; 95% CI, 0.06-0.71) were independently associated with a decreased rate of ineffective electrical cardioversion.
背景
现有研究表明，沙库巴曲缬沙坦可改善心房颤动（AF）患者的心房重构，并有助于维持AF合并心力衰竭患者的窦性心律。然而，沙库巴曲缬沙坦对持续性AF患者的影响尚不清楚。我们旨在评估沙库巴曲缬沙坦对接受电复律（ECV）的持续性AF患者恢复和维持窦性心律的影响。
方法
在这项回顾性队列研究中，对2016年1月1日至2020年9月30日期间接受ECV的持续性AF连续患者进行了调查。所有符合条件的患者根据是否接受沙库巴曲缬沙坦治疗分为沙库巴曲缬沙坦使用者和非使用者。终点为无效ECV，定义为在30天随访期间未能终止AF或AF任何复发的复合情况。
结果
本研究共纳入76例患者，其中28例沙库巴曲缬沙坦使用者和48例非使用者。在ECV后30天的随访中，28例沙库巴曲缬沙坦使用者中有7例（25%）出现终点事件，48例非使用者中有25例（52%）出现终点事件。Kaplan-Meier生存曲线显示，沙库巴曲缬沙坦使用者的无效ECV发生率显著低于非使用者（ = 0.02；对数秩检验）。多变量Cox回归分析表明，使用沙库巴曲缬沙坦（风险比[HR]，0.35；95%置信区间[CI]，0.14 - 0.91）、使用胺碘酮（HR，0.32；95% CI，0.13 - 0.78）、左心房直径≤39 mm（HR，0.21；95% CI，0.06 - 0.71）与无效电复律率降低独立相关。
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