Park Yoonjee, Bak Minjung, Shin Heayoung, Hong David, Yang Jeong Hoon, Kim Darae, Jeon Eun-Seok, Choi Jin-Oh
Department of Cardiology, Bucheon Sejong Hospital, 28, Bucheon-si 14754, Republic of Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Medicina (Kaunas). 2025 Aug 19;61(8):1487. doi: 10.3390/medicina61081487.
: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to a renin-angiotensin system blocker (RASB). : A total of 354 patients with recovered LVEF of at least 40% after S/V treatment from a single center were retrospectively analyzed. Patients were categorized into three groups: those who continued S/V ( = 294), those who switched to RASB ( = 47), and those who discontinued both S/V and RASB ( = 13). The primary endpoint was HF relapse, defined as a two-fold increase in baseline serum N-terminal-pro hormone B-type natriuretic peptide (NT-proBNP) concentration exceeding 400 pg/dL. Secondary endpoints included the ratio and difference between baseline and peak NT-proBNP levels. : Baseline clinical characteristics were well balanced among groups. Over a median follow-up of 399 (252-589) days, HF relapse occurred more frequently in patients who discontinued both S/V and RASB compared to those who maintained either treatment (53.8% vs. 16.3% vs. 10.6%; = 0.001). NT-proBNP levels also showed a more pronounced increase in this group. However, there were no significant differences in primary or secondary outcomes between the S/V and RASB groups. : Our findings suggest that replacing S/V with another RASB does not worsen outcomes in patients with HFimpEF after S/V treatment, whereas discontinuation of both therapies is associated with a significantly higher risk of HF relapse. A prospective trial is warranted to confirm the safety and effectiveness of this approach in maintaining remission.
左心室射血分数（LVEF）改善后的最佳药物治疗仍 largely 未知。本研究比较了基于沙库巴曲缬沙坦（S/V）维持治疗或转换为肾素-血管紧张素系统阻滞剂（RASB）的射血分数改善的心力衰竭（HF）患者的临床结局。：对来自单一中心的 354 例经 S/V 治疗后 LVEF 恢复至至少 40% 的患者进行回顾性分析。患者分为三组：继续使用 S/V 的患者（= 294）、转换为 RASB 的患者（= 47）以及停用 S/V 和 RASB 的患者（= 13）。主要终点是 HF 复发，定义为基线血清 N 末端前体激素 B 型利钠肽（NT-proBNP）浓度增加两倍且超过 400 pg/dL。次要终点包括基线和峰值 NT-proBNP 水平之间的比值和差值。：各组间基线临床特征均衡良好。在中位随访 399（252 - 589）天期间，与维持任何一种治疗的患者相比，停用 S/V 和 RASB 的患者 HF 复发更频繁（53.8% 对 16.3% 对 10.6%；= 0.001）。该组 NT-proBNP 水平也有更明显的升高。然而，S/V 组和 RASB 组在主要或次要结局方面无显著差异。：我们的研究结果表明，在 S/V 治疗后，用另一种 RASB 替代 S/V 不会使 HFimpEF 患者的结局恶化，而两种治疗均停用与 HF 复发风险显著升高相关。有必要进行一项前瞻性试验来证实这种方法在维持缓解方面的安全性和有效性。
