沙库巴曲缬沙坦对维持性血液透析伴中间范围或射血分数保留心力衰竭患者的影响：单中心前瞻性研究的真实世界经验。
Effect of sacubitril valsartan on heart failure with mid-range or preserved ejection fraction in patients on maintenance hemodialysis: real-world experience in a single-center, prospective study.
机构信息
Department of Nephrology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, China.
Department of Ultrasound, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, China.
出版信息
BMC Cardiovasc Disord. 2024 Jan 30;24(1):79. doi: 10.1186/s12872-024-03744-y.
BACKGROUND
This study aimed to evaluate the effect of sacubitril valsartan (SV) on heart failure (HF) hospitalization and cardiovascular mortality in patients on hemodialysis with HF with preserved ejection fraction (EF; HFpEF).
METHODS
This single-center, prospective study enrolled 155 stable hemodialysis patients with EF > 40% who were followed up for 12 months. Fifty-nine patients were treated with SV; the others were matched for EF (57.89 ± 9.35 vs. 58.00 ± 11.82, P = 0.9) at a ratio of 1:1 and included as controls. The target dosage of SV was 200 mg/day.
RESULTS
Twenty-three (23/155; 14.84%) had HF with mid-range EF (HFmrEF), while 132 (85.16%) had HFpEF. After SV treatment, the peak early diastolic transmitral flow velocity/peak early diastolic mitral annular tissue velocity(E/e') improved from 17.19 ± 8.74 to 12.80 ± 5.52 (P = 0.006), the left ventricular (LV) end-diastolic diameter decreased from 53.14 ± 7.67 mm to 51.56 ± 7.44 mm (P = 0.03), and the LV mass index decreased from 165.7 ± 44.6 g/m to 154.8 ± 24.0 g/m (P = 0.02). LVEF (P = 0.08) and LV global longitudinal strain (P = 0.7) did not change significantly. The composite outcome of first and recurrent HF hospitalization or cardiovascular death showed no difference between group. However, the Acute Dialysis Quality Initiative Workgroup (ADQI) HF class improved in 39 and 15 patients and worsened in 1 and 11 patients in the SV and control groups, respectively (P < 0.001). Age, diabetes mellitus, and pulmonary arterial pressure were independent risk factors for HF hospitalization and cardiovascular mortality in patients with HFpEF.
CONCLUSIONS
SV improved LV hypertrophy, diastolic function, and the ADQI class for HF; however, it failed to reduce the composite endpoints of HF hospitalization and cardiovascular disease-related mortality over 12 months of follow-up in patients on maintenance hemodialysis with EF of > 40%.
背景
本研究旨在评估沙库巴曲缬沙坦（SV）对射血分数保留的心力衰竭（HFpEF）伴心力衰竭（HF）且接受血液透析的患者的 HF 住院和心血管死亡率的影响。
方法
这项单中心前瞻性研究纳入了 155 名 EF>40%且病情稳定的接受血液透析的 HFpEF 患者，随访 12 个月。59 名患者接受 SV 治疗；其他患者按照 EF（57.89±9.35 比 58.00±11.82，P=0.9）的 1:1 比例匹配作为对照组。SV 的目标剂量为 200mg/天。
结果
23 名（23/155；14.84%）患者为 HF 伴中间范围射血分数（HFmrEF），132 名（85.16%）患者为 HFpEF。SV 治疗后，峰值早期舒张期二尖瓣血流速度/早期舒张期二尖瓣环组织速度（E/e'）从 17.19±8.74 改善至 12.80±5.52（P=0.006），左心室（LV）舒张末期直径从 53.14±7.67mm 减小至 51.56±7.44mm（P=0.03），LV 质量指数从 165.7±44.6g/m2 减小至 154.8±24.0g/m2（P=0.02）。左心室射血分数（P=0.08）和左心室整体纵向应变（P=0.7）无显著变化。SV 组和对照组的首次和复发性 HF 住院或心血管死亡的复合终点无差异。然而，SV 组和对照组的急性透析质量倡议工作组（ADQI）HF 分级分别有 39 名和 15 名患者改善，1 名和 11 名患者恶化（P<0.001）。年龄、糖尿病和肺动脉压是 HFpEF 患者 HF 住院和心血管死亡率的独立危险因素。
结论
SV 改善了 LV 肥厚、舒张功能和 HF 的 ADQI 分级；然而，在 12 个月的随访中，SV 未能降低 EF>40%且接受维持性血液透析的 HFpEF 患者的 HF 住院和心血管疾病相关死亡率的复合终点。
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