Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina.
Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina.
Med Arch. 2022 Apr;76(2):101-107. doi: 10.5455/medarh.2022.76.101-107.
The prevalence of chronic heart failure (CHF) is up to 1-2% of the adult population in developed countries, rising to >10% after the age of 70. Heart failure with reduced ejection fraction (HFrEF) remains a prevalent clinical syndrome associated with significant morbidity and mortality.
The aim of this study was to evaluate the clinical efficacy of sacubitril/valsartan in a group of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) and its effect on the hemodynamic, metabolic, renal, and cardiac remodeling parameters.
From January 2018 to May 2021, 106 patients with chronic heart failure with reduced ejection fraction (HFrEF) were prospectively enrolled. Patients treated with sacubitril/valsartan (ARNI) were compared with an arm of the same size (n = 53) and matched by age and gender who were taking a standard optimal medical therapy for HFrEF.
The 106 patients completing the study were characterized by age: 69.5 ± 8.0, 64% are male gender. The mean duration of follow-up in the 2 treatment arms was 12 months. In the ARNI arm, we evaluate the hemodynamic, metabolic, renal, and cardiac remodeling parameters upon the initial evaluation and at the end of the follow-up after 12 months treatment with sacubitril/valsartan. The LVEF values increased significantly (p < 0.001) in the ARNI arm compared to the OMT arm, 42.1 % vs. 30.1%. The LVMI decreased from a baseline value of 153.1 g/m2 to 147.8 g/m2 with significant improvement only in the arm treated with ARNI. The eGFR values increased significantly (p < 0.001) in the ARNI arm compared to the OMT arm 70.1 vs. 64.9 mL/min/1.73 m2. Initiation and titration of sacubitril-valsartan was associated with a reduction in NT-pro-BNP concentration, the values of NT-pro-BNP improved significantly only in the arm treated with ARNI 3107.1 vs. 5678.2. Mortality and re-hospitalization due to HF were lower in the arm treated with ARNI compared to the control (20.3 vs. 32.4 % and 25.3 vs. 46.6 %, respectively; p < 0.05).
Sacubitril/valsartan is an important advancement in the treatment of HFrEF. Sacubitril/valsartan induce "hemodynamic recovery". This study provides real-world data demonstrating incremental improvements in functional and echocardiographic outcomes in optimally treated patients with HFrEF switched to sacubitril/valsartan in ambulatory setting.
慢性心力衰竭（CHF）的患病率在发达国家高达成人人口的 1-2%，在 70 岁后上升至>10%。射血分数降低的心力衰竭（HFrEF）仍然是一种常见的临床综合征，与显著的发病率和死亡率相关。
本研究旨在评估沙库巴曲缬沙坦在一组射血分数降低的心力衰竭（HFrEF）门诊患者中的临床疗效及其对血流动力学、代谢、肾脏和心脏重构参数的影响。
从 2018 年 1 月至 2021 年 5 月，前瞻性纳入了 106 例射血分数降低的慢性心力衰竭（HFrEF）患者。接受沙库巴曲缬沙坦（ARNI）治疗的患者与相同大小的一组（n=53）进行比较，并按年龄和性别进行匹配，这些患者接受了 HFrEF 的标准最佳药物治疗。
完成研究的 106 例患者的特征为年龄：69.5±8.0，64%为男性。在 2 个治疗组中，平均随访时间为 12 个月。在 ARNI 组中，我们评估了在开始接受沙库巴曲缬沙坦治疗后的初始评估和 12 个月的随访结束时的血流动力学、代谢、肾脏和心脏重构参数。与 OMT 组相比，ARNI 组的 LVEF 值显著增加（p<0.001），分别为 42.1%和 30.1%。与基线值相比，LVMI 从 153.1g/m2 下降至 147.8g/m2，仅在接受 ARNI 治疗的组中观察到显著改善。与 OMT 组相比，eGFR 值在 ARNI 组中显著增加（p<0.001），分别为 70.1 和 64.9mL/min/1.73m2。沙库巴曲缬沙坦的起始和滴定与 NT-pro-BNP 浓度的降低有关，只有在接受 ARNI 治疗的组中，NT-pro-BNP 的值显著改善，分别为 3107.1 和 5678.2。与对照组相比，接受 ARNI 治疗的组的死亡率和因心力衰竭再住院率较低（分别为 20.3%和 32.4%和 25.3%和 46.6%；p<0.05）。
沙库巴曲缬沙坦是治疗 HFrEF 的重要进展。沙库巴曲缬沙坦诱导“血流动力学恢复”。本研究提供了真实世界的数据，证明在最佳治疗的 HFrEF 患者中，切换至沙库巴曲缬沙坦可改善功能和超声心动图结局。
