Divison of Internal Medicine, University of Miami Health System, Miami, Florida.
University of Miami Miller School of Medicine, Miami, Florida.
Am J Cardiol. 2023 Oct 1;204:360-365. doi: 10.1016/j.amjcard.2023.07.140. Epub 2023 Aug 11.
Randomized controlled trials have demonstrated mortality benefits for several medication classes in patients with heart failure (HF), especially with reduced ejection fraction (EF). However, the benefit of these traditional HF therapies in patients with HF from cardiac amyloidosis is unclear. our study aimed to evaluate the safety and efficacy of traditional HF therapies in patients with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF (HFmrEF). We conducted a single-center retrospective study. Patients were included if they were diagnosed with cardiac amyloidosis and HF with reduced EF or HF with mid-range EF between January 2012 and 2022. The primary outcomes of interest were medication use patterns (for β blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], angiotensin receptor blockers [ARBs], angiotensin receptor neprilysin inhibitors [ARNI], and mineralocorticoid receptor antagonists [MRAs]); potential medication side effects (symptomatic bradycardia, fatigue, hypotension, lightheadedness, and syncope); hospitalization; and death. The associations of BB, ACEI/ARB/ARNI, and MRA use with clinical outcomes were evaluated using Kaplan-Meier and Cox proportional hazards regression. A total of 82 patients met study criteria. At time of cardiac amyloidosis diagnosis, 63.4% were on a BB, 51.2% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. At last follow-up, 51.2% were on a BB, 35.4% were on an ACEI/ARB/ARNI, and 43.9% were on an MRA. There were no statistically significant differences in rates of potential medication side effects in patients on the medication class compared with those who were not. There was no association with hospitalization or mortality for baseline or follow-up BB, ACEI/ARB/ARNI, or MRA use. In conclusion, BBs, ACEI/ARB/ARNIs, and MRAs may be safely used in this population. However, their use does not appear to improve mortality or hospitalization.
随机对照试验已经证明，几种药物类别对心力衰竭（HF）患者，特别是射血分数降低（EF）的患者具有死亡率益处。然而，这些传统 HF 疗法在心衰合并心脏淀粉样变性患者中的益处尚不清楚。我们的研究旨在评估传统 HF 疗法在心衰合并射血分数降低或射血分数中间值的 HF（HFmrEF）患者中的安全性和疗效。我们进行了一项单中心回顾性研究。如果患者在 2012 年 1 月至 2022 年间被诊断为心脏淀粉样变性和射血分数降低的 HF 或射血分数中间值的 HF，则将其纳入研究。主要关注的结局是药物使用模式（β受体阻滞剂[BB]、血管紧张素转换酶抑制剂[ACEI]、血管紧张素受体阻滞剂[ARB]、血管紧张素受体脑啡肽酶抑制剂[ARNI]和盐皮质激素受体拮抗剂[MRA]）；潜在的药物副作用（症状性心动过缓、疲劳、低血压、头晕和晕厥）；住院治疗；和死亡。使用 Kaplan-Meier 和 Cox 比例风险回归评估 BB、ACEI/ARB/ARNI 和 MRA 使用与临床结局的关系。共有 82 名患者符合研究标准。在诊断为心脏淀粉样变性时，63.4%的患者使用 BB，51.2%的患者使用 ACEI/ARB/ARNI，43.9%的患者使用 MRA。在最后一次随访时，51.2%的患者使用 BB，35.4%的患者使用 ACEI/ARB/ARNI，43.9%的患者使用 MRA。在使用该药物类别的患者与未使用该药物类别的患者相比，潜在药物副作用的发生率没有统计学差异。BB、ACEI/ARB/ARNI 或 MRA 的基线或随访使用与住院或死亡率均无关联。总之，BB、ACEI/ARB/ARNI 和 MRA 可在该人群中安全使用。然而，它们的使用似乎并不能改善死亡率或住院率。
