Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Division of Epidemiology, Kobe University Graduate School of Medicine, Kobe, Japan.
Heart Vessels. 2024 Feb;39(2):95-104. doi: 10.1007/s00380-023-02311-3. Epub 2023 Sep 21.
Sacubitril/valsartan has become an important first-line drug for symptomatic heart failure (HF) patients, especially with left ventricular (LV) ejection fraction (LVEF) < 50%. However, the impact of sacubitril/valsartan on cardiovascular outcomes, especially LV reverse remodeling for such patients with low blood pressure, remains uncertain. We retrospectively studied 164 HF patients with LVEF < 50% who were treated with sacubitril/valsartan from two institutions. Echocardiography was performed before and 9.5 ± 5.1 months after initiation of maximum tolerated dose of sacubitril/valsartan. The maximum tolerated dose of sacubitril/valsartan was lower for the low blood pressure group (≤ 100 mmHg in systole) than for the non-low blood pressure group (> 100 mmHg in systole) (165 ± 106 mg vs. 238 ± 124 mg, P = 0.017). As expected, significant LV reverse remodeling was observed in the non-low blood pressure group after initiation of sacubitril/valsartan. It was noteworthy that significant LV reverse remodeling was also observed in the low blood pressure group after initiation of sacubitril/valsartan (LV end-diastolic volume: 177.3 ± 66.0 mL vs. 137.7 ± 56.1 mL, P < 0.001, LV end-systolic volume: 131.6 ± 60.3 mL vs. 94.6 ± 55.7 mL, P < 0.001, LVEF: 26.8 ± 10.3% vs. 33.8 ± 13.6%, P = 0.015). Relative changes in LV volumes and LVEF after initiation of sacubitril/valsartan were similar for the two groups. In conclusion, significant LV reverse remodeling occurred after initiation of sacubitril/valsartan, even in HF patients with LVEF < 50% and systolic blood pressure ≤ 100 mmHg.
沙库巴曲缬沙坦已成为有症状心力衰竭（HF）患者，尤其是左心室射血分数（LVEF）<50%患者的重要一线治疗药物。然而，沙库巴曲缬沙坦对心血管结局的影响，尤其是对血压较低的此类患者的左心室逆向重构，仍不确定。我们回顾性研究了来自两个机构的 164 名 LVEF<50%的 HF 患者，这些患者接受了沙库巴曲缬沙坦治疗。在开始最大耐受剂量的沙库巴曲缬沙坦前和 9.5±5.1 个月后进行超声心动图检查。低血压组（收缩压≤100mmHg）的沙库巴曲缬沙坦最大耐受剂量低于非低血压组（收缩压>100mmHg）（165±106mg 比 238±124mg，P=0.017）。正如预期的那样，在开始沙库巴曲缬沙坦治疗后，非低血压组出现了显著的左心室逆向重构。值得注意的是，在开始沙库巴曲缬沙坦治疗后，低血压组也出现了显著的左心室逆向重构（LV 舒张末期容积：177.3±66.0mL 比 137.7±56.1mL，P<0.001，LV 收缩末期容积：131.6±60.3mL 比 94.6±55.7mL，P<0.001，LVEF：26.8±10.3%比 33.8±13.6%，P=0.015）。两组患者开始沙库巴曲缬沙坦治疗后 LV 容积和 LVEF 的相对变化相似。总之，即使在 LVEF<50%且收缩压≤100mmHg 的 HF 患者中，开始沙库巴曲缬沙坦治疗后也会出现显著的左心室逆向重构。
