Rubio-Campal José-Manuel, Rodriguez Lopez Carlos, Lázaro Rivera Carla, de Asís Díaz Cortegana Francisco, Bravo Calero Loreto, Aguilera Agudo Cristina, Romero-Otero José María, Tuñón Fernández José
Hospital Universitario Fundación Jiménez Díaz-Quirón salud, Madrid, Spain.
Cardiol J. 2025;32(3):270-277. doi: 10.5603/cj.104310. Epub 2025 May 22.
Sacubitril/valsartan (S/V) improve left ventricular ejection fraction (LVEF) in heart failure patients, but the magnitude of improvement may depend on baseline values.
We analyzed whether baseline LVEF can predict its improvement in patients with LVEF ≤ 45% receiving S/V. Patients were divided into 4 groups (G) according to baseline LVEF (G1: ≤ 20%; G2: 21-30%; G3: 31-40%; G4: 41-45%).
We included 256 patients (age 73 ± 12 years; 73% male; 174 ischemic cardiomyopathy [CM], 82 nonischemic CM) and assessed LVEF at S/V initiation and at 6 and 12 months of therapy. Baseline LVEF (%) values (overall 30.9 ± 8.6) were: G1: 17.3 ± 3.3; G2: 27.5 ± 2.4; G3: 35.5 ± 2; G4: 44.4 ± 1. LVEF increased in 62% of patients, reaching 34.3 ± 10.4% and 35.5 ± 11.2% at 6 and 12 months, respectively (p < 0.001). A significantly higher absolute LVEF increase was found in Groups 3 (7.2 ± 4.3) and 4 (4.2 ± 3.05) than in Groups 1 (0.6 ± 1.5) and 2 (3.5 ± 1.5), in women (5.9 ± 4.4 vs. 4.1 ± 4.5; p < 0.001), with high S/V doses (7.4 ± 4.7 vs. 4.3 ± 4.4; p < 0.001), and in nonischemic CM (6.3 ± 4.9 vs. 3.8 ± 4.2; p < 0.001). On multivariate analysis, female sex (OR 2.18; 95% CI [1.06-4.48]; p = 0.034), high dose (OR 3.38; 95% CI [1.10-10.34]; p = 0.033), and baseline LVEF > 30% (OR 8.62; 95% CI [4.69-15.82]; p = 0.001) were significant predictors of LVEF improvement.
LVEF improvement with S/V depends on baseline values, sex, and dose.
沙库巴曲缬沙坦（S/V）可改善心力衰竭患者的左心室射血分数（LVEF），但改善程度可能取决于基线值。
我们分析了基线LVEF是否能够预测LVEF≤45%的患者接受S/V治疗后的改善情况。根据基线LVEF将患者分为4组（G）：G1组：≤20%；G2组：21%-30%；G3组：31%-40%；G4组：41%-45%。
我们纳入了256例患者（年龄73±12岁；73%为男性；174例缺血性心肌病[CM]，82例非缺血性CM），并在开始使用S/V时以及治疗6个月和1年后评估LVEF。基线LVEF（%）值（总体为30.9±8.6）分别为：G1组：17.3±3.3；G2组：27.5±2.4；G3组：35.5±2；G4组：44.4±1。62%的患者LVEF升高，在6个月和12个月时分别达到34.3±10.4%和35.5±11.2%（p<0.001）。与G1组（0.6±1.5）和G2组（3.5±1.5）相比，G3组（7.2±4.3）和G4组（4.2±3.05）的LVEF绝对升高幅度显著更高，女性（5.9±4.4对4.1±4.5；p<0.001）、高剂量S/V（7.4±4.7对4.3±4.4；p<0.001）以及非缺血性CM患者（6.3±4.9对3.8±4.2；p<0.001）也是如此。多因素分析显示，女性（OR 2.18；95%CI[1.06-4.48]；p=0.034）、高剂量（OR 3.38；95%CI[1.10-10.34]；p=0.033）以及基线LVEF>30%（OR 8.62；95%CI[4.69-15.82]；p=0.001）是LVEF改善的显著预测因素。
S/V对LVEF的改善取决于基线值、性别和剂量。
