沙库巴曲缬沙坦降低导管消融术后房颤复发率及左心房容积：系统评价与荟萃分析
Sacubitril-Valsartan Lowers Atrial Fibrillation Recurrence and Left Atrial Volume Post-catheter Ablation: Systematic Review and Meta-Analysis.
作者信息
de Lucena Larissa Araújo, Freitas Marcos Aurélio Araújo, Guida Camila Mota, Hespanhol Larissa C, de Sousa Ana Karenina C, de Sousa Júlio César V, Maia Ferdinand Gilbert S
机构信息
Department of Integrated Medicine, Federal University of Rio Grande do Norte, 620 Nilo Peçanha Avenue, Petrópolis, Natal, Rio Grande do Norte, 59012-300, Brazil.
Department of Medicine, State University of Região Tocantina do Maranhão, Imperatriz, Maranhão, Brazil.
出版信息
Am J Cardiovasc Drugs. 2025 Mar;25(2):157-167. doi: 10.1007/s40256-024-00691-z. Epub 2024 Oct 29.
INTRODUCTION
In patients with atrial fibrillation (AF) who have undergone catheter ablation, the comparative effectiveness of sacubitril-valsartan (SV) versus ACE inhibitors (ACEi) or angiotensin-receptor blockers (ARB) in preventing AF recurrence remains unclear. The purpose of the present systematic review and meta-analysis is to determine whether SV offers superior outcomes in this clinical setting.
METHODS
This study systematically reviewed PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and propensity-matched cohorts (PMC), evaluating SV's efficacy in preventing AF recurrence after catheter ablation. Outcomes included AF recurrence and structural remodeling assessed via left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi), with statistical analyses performed using Review Manager 5.1.7 and heterogeneity assessed via I statistics.
RESULTS
The analysis comprised 642 patients from three RCTs and one PMC (319 SV-treated). SV significantly reduced AF recurrence [risk ratios (RR) 0.54; 95% confidence intervals (CI) 0.41-0.70; p < 0.00001; I = 0%), a trend also observed when considering RCTs exclusively (RR 0.58; 95% CI 0.41-0.84; p = 0.004; I = 0%). Moreover, SV demonstrated a notable reduction in LAVi [mean deviation (MD) -5.34 mL/m; 95% CI -8.77 to -1.91; p = 0.002; I = 57%] compared with ARB, alongside a significant improvement in LVEF (MD 1.83%; 95% CI 1.35-2.32; p < 0.00001; I = 0%). Subgroup analyses among patients with hypertension and LVEF < 50% also indicated lower AF recurrence with SV.
CONCLUSION
SV therapy exhibited superior efficacy in reducing AF recurrence compared with ACEi or ARB and demonstrated superior outcomes in attenuating atrial structural remodeling after catheter ablation. These findings underscore the potential of SV as a therapeutic option for patients with AF undergoing catheter ablation, highlighting its efficacy in mitigating AF recurrence and structural remodeling.
REGISTRATION
PROSPERO identifier number CRD42024497958.
引言
在接受导管消融术的心房颤动（AF）患者中，沙库巴曲缬沙坦（SV）与血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）在预防房颤复发方面的相对有效性仍不明确。本系统评价和荟萃分析的目的是确定在这种临床情况下，SV是否能提供更好的治疗效果。
方法
本研究系统检索了PubMed、Embase和Cochrane图书馆，以查找随机对照试验（RCT）和倾向匹配队列（PMC），评估SV在预防导管消融术后房颤复发方面的疗效。观察指标包括房颤复发以及通过左心室射血分数（LVEF）和左心房容积指数（LAVi）评估的结构重塑，使用Review Manager 5.1.7进行统计分析，并通过I统计量评估异质性。
结果
分析纳入了来自三项RCT和一项PMC的642例患者（319例接受SV治疗）。SV显著降低了房颤复发率[风险比（RR）0.54；95%置信区间（CI）0.41 - 0.70；p < 0.00001；I = 0%]，仅考虑RCT时也观察到这一趋势（RR 0.58；95% CI 0.41 - 0.84；p = 0.004；I = 0%）。此外，与ARB相比，SV使LAVi显著降低[平均差值（MD）-5.34 mL/m²；95% CI -8.77至-1.91；p = 0.002；I = 57%]，同时LVEF有显著改善（MD 1.83%；95% CI 1.35 - 2.32；p < 0.00001；I = 0%）。高血压和LVEF < 50%患者的亚组分析也表明，SV组房颤复发率较低。
结论
与ACEi或ARB相比，SV治疗在降低房颤复发方面显示出更好的疗效，并且在减轻导管消融术后心房结构重塑方面也表现出更好的效果。这些发现强调了SV作为接受导管消融术的房颤患者治疗选择的潜力，突出了其在减轻房颤复发和结构重塑方面的疗效。
注册信息
PROSPERO标识符编号CRD42024497958。
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