Bin Atan Noor Muhammad Azlan Shah, Bin Hadi Mohd Firdaus, Teoh Victoria Wen Yeng, Danaee Mahmoud, Loch Alexander
Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Department of Social and Preventive Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
J Cardiovasc Pharmacol Ther. 2023 Jan-Dec;28:10742484231195019. doi: 10.1177/10742484231195019.
Ventricular remodeling is a mal-adaptive process. Both angiotensin-converting enzyme inhibitors and sacubitril/valsartan have been shown to reverse remodeling in mostly uncontrolled observational studies. There is a lack of head-to-head studies. This cohort study compares the remodeling effects of angiotensin receptor blockers combined with a neprilysin inhibitor (ARNI) and perindopril in heart failure with reduced ejection fraction (HFrEF) patients between January 2017 and December 2020. Inclusion criteria: (i) age > 18 years, (ii) recent diagnosis of de-novo HFrEF (EF < 40%), (iii) baseline echocardiography performed not more than 2 months prior to treatment onset, and (iv) follow-up echocardiography performed not earlier than 6 months and not later than 18 months posttreatment onset. No prior treatment with renin-angiotensin-aldosterone system inhibitors was permitted in the ARNI group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) were analyzed. A two-way repeated measure ANOVA (for normally distributed) and generalized estimating equation test for nonnormally distributed interval dependent variables. Mean comparison between and within groups was performed using the Bonferroni test. Following an average treatment period of 9 months, LVEF improved from 24.9% to 36.4% for ARNI and from 28.7% to 40.5% for perindopril, increments of 11.5% and 11.8% resp. (Bonferroni test [ ≤ .05]). LVEDV was reduced by 8.4 mL and 3.2 mL, and LVESV by 17.9 mL and 10.8 mL for ARNI and perindopril resp. Only the reduction of LVESV for ARNI was statistically significant ( = .007). Both ARNI and perindopril yielded a significant improvement in the LVEF within 9 months. The remodeling effect of ARNI seems stronger because of the greater improvements in left ventricular volumes.
心室重塑是一个适应不良的过程。在大多未得到严格控制的观察性研究中，血管紧张素转换酶抑制剂和沙库巴曲缬沙坦均已显示出可逆转重塑。目前缺乏直接对比的研究。这项队列研究比较了2017年1月至2020年12月期间，血管紧张素受体阻滞剂联合中性肽链内切酶抑制剂（ARNI）与培哚普利对射血分数降低的心力衰竭（HFrEF）患者的重塑作用。纳入标准：（i）年龄>18岁；（ii）近期初诊为新发HFrEF（EF<40%）；（iii）在治疗开始前不超过2个月进行基线超声心动图检查；（iv）在治疗开始后不早于6个月且不晚于18个月进行随访超声心动图检查。ARNI组不允许先前使用肾素-血管紧张素-醛固酮系统抑制剂进行治疗。分析左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）和左心室收缩末期容积（LVESV）。对正态分布的变量采用双向重复测量方差分析，对非正态分布的区间相关变量采用广义估计方程检验。组间和组内均值比较采用Bonferroni检验。经过平均9个月的治疗期后，ARNI组的LVEF从24.9%提高到36.4%，培哚普利组从28.7%提高到40.5%，分别增加了11.5%和11.8%（Bonferroni检验[≤0.05]）。ARNI组和培哚普利组的LVEDV分别减少了8.4mL和3.2mL，LVESV分别减少了17.9mL和10.8mL。只有ARNI组LVESV的减少具有统计学意义（P=0.007）。ARNI和培哚普利在9个月内均使LVEF有显著改善。由于左心室容积有更大改善，ARNI的重塑作用似乎更强。
