维立西呱在射血分数降低的心力衰竭恶化后患者管理中的作用。
Role of vericiguat in management of patients with heart failure with reduced ejection fraction after worsening episode.
机构信息
Heart Failure Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Vall d'Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
出版信息
ESC Heart Fail. 2024 Apr;11(2):628-636. doi: 10.1002/ehf2.14647. Epub 2023 Dec 29.
Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.
心力衰竭(HF)恶化是一个脆弱时期,患者死亡或因 HF 住院的风险明显升高(分别在发作后最初几周内高达 10%和 30%)。通过综合考虑不同的神经激素系统,可以改善 HF 患者的预后,早期引入并优化沙库巴曲缬沙坦、β受体阻滞剂、盐皮质激素受体拮抗剂和抑制剂的四联疗法。尽管如此,仍存在这些疗法无法靶向的残余风险。目前,人们认识到环鸟苷单磷酸缺乏对 HF 发病机制有直接的负面影响,维立西呱是一种可溶性鸟苷酸环化酶的口服刺激剂,可恢复该途径。维立西呱的疗效已在 VICTORIA 研究中得到探索,这是一项针对近期 HF 恶化患者的最大慢性 HF 临床试验,结果表明,在标准治疗的基础上加用维立西呱可使主要复合终点(心血管死亡或 HF 住院)的风险降低 10%(需要治疗 24 例)。该获益与背景 HF 治疗无关。因此,应尽快进行治疗优化,特别是在脆弱时期,还应考虑使用维立西呱。