Lund Lars H, Zeymer Uwe, Clark Andrew L, Barrios Vivencio, Damy Thibaud, Drożdż Jaroslaw, Fonseca Candida, Kalus Stefanie, Ferber Philippe C, Koch Cornelia, Maggioni Aldo P
Department of Medicine, Karolinska Institutet, And Heart Vascular and Neuro Theme Karolinska University Hospital, Stockholm, Sweden.
Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen-am-Rhein, Germany.
Int J Cardiol. 2023 Jan 1;370:279-286. doi: 10.1016/j.ijcard.2022.10.012. Epub 2022 Oct 7.
We tested the hypothesis that initiation versus non-initiation of sacubitril/valsartan is associated with a more favorable subsequent change in left ventricular ejection fraction (LVEF) in a real-world setting.
A prospective, non-randomized, double-arm, open-label, cohort study had been conducted across 687 centers in 17 European countries enrolling HFrEF patients aged ≥18 years with symptoms of HF (New York Heart Association [NYHA] II-IV) and "reduced LVEF". For the current analysis, 2602 patients with LVEF measured at baseline and follow-up were chosen, of which 860 (33%, mean age 67 years, 26% women) were started on sacubitril/valsartan at baseline and 1742 (67%, 68 years, 23% women) were not. Patients started on sacubitril/valsartan had higher NYHA class and lower LVEF.
LVEF increased from mean 32.7% to 38.1% in the sacubitril/valsartan group versus from 35.9% to 38.7% in the non-sacubitril/valsartan group (mean difference in increase 2.6%, p < 0.001). LVEF increased from baseline in 64% versus 53% of patients and increased by ≥5% (absolute %) in 50% versus 35% of patients in the sacubitril/valsartan versus non-sacubitril/valsartan groups, respectively. In the overall cohort, initiation of sacubitril/valsartan was independently associated with any increase in LVEF (adjusted odds ratio [OR] 1.49 [1.26-1.75]) and with increase by ≥5% (OR 1.65 [1.39-1.95]).
Initiating versus not initiating sacubitril/valsartan was independently associated with a greater subsequent increase in LVEF in this real-world setting. Reverse cardiac remodeling may be one mechanism of benefit of sacubitril/valsartan.
我们检验了这样一个假设，即在现实环境中，沙库巴曲缬沙坦的起始治疗与未起始治疗相比，是否与左心室射血分数（LVEF）随后更有利的变化相关。
在17个欧洲国家的687个中心开展了一项前瞻性、非随机、双臂、开放标签的队列研究，纳入年龄≥18岁、有心力衰竭症状（纽约心脏协会[NYHA]II-IV级）且“LVEF降低”的射血分数降低的心力衰竭（HFrEF）患者。对于当前分析，选择了2602例在基线和随访时测量了LVEF的患者，其中860例（33%，平均年龄67岁，26%为女性）在基线时开始使用沙库巴曲缬沙坦，1742例（67%，68岁，23%为女性）未使用。开始使用沙库巴曲缬沙坦的患者NYHA分级更高，LVEF更低。
沙库巴曲缬沙坦组的LVEF从平均32.7%增加到38.1%，而非沙库巴曲缬沙坦组从35.9%增加到38.7%（增加的平均差异为2.6%，p<0.001）。沙库巴曲缬沙坦组与非沙库巴曲缬沙坦组分别有64%和53%的患者LVEF从基线升高，且分别有50%和35%的患者LVEF升高≥5%（绝对百分比）。在整个队列中，起始使用沙库巴曲缬沙坦与LVEF的任何升高独立相关（调整后的优势比[OR]为1.49[1.26-1.75]）以及与升高≥5%相关（OR为1.65[1.39-1.95]）。
在这个现实环境中，起始与未起始使用沙库巴曲缬沙坦与随后LVEF更大幅度的升高独立相关。心脏逆向重构可能是沙库巴曲缬沙坦获益的一种机制。
