沙库巴曲/缬沙坦治疗扩张型心肌病合并心力衰竭一例

Sacubitril/valsartan in treatment of dilated cardiomyopathy complicated with heart failure: a case report

血管紧张素受体-脑啡肽酶抑制剂(ARNI)沙库巴曲/缬沙坦对扩张型心肌病(DCM)合并射血分数减低心力衰竭(HFrEF)及复杂心律失常治疗效果仍不明确。该文报道了1例52岁男性,因发现心率慢8年余,胸闷头晕3个月入院,诊断为DCM、心力衰竭、室性心动过速、心房颤动、心房扑动。行植入型体内自动除颤器植入术,术后予β受体拮抗剂、ACEI、醛固酮拮抗剂、利尿剂等药物治疗,效果不佳,后更换ACEI为ARNI(沙库巴曲/缬沙坦)治疗3个月,起始剂量为100 mg,每日2次,服药3个月后患者LVEF从42%升至54%,N-端脑钠肽前体降低,6 min步行距离增加,室性期前收缩及室性心动过速减少,说明起始剂量100 mg的沙库巴曲/缬沙坦治疗DCM合并HFrEF及复杂心律失常安全,效果或优于ACEI类药物。

The clinical efficacy of angiotensin receptor-neprilysin inhibitor(ARNI)-sacubitril/valsartan in the treatment of dilated cardiomyopathy complicated with heart failure reduced ejection fraction(HFrEF) and complex arrhythmia remain elusive.In this article,a 52-year-old male patient was admitted to our hospital due to an 8-year history of progressive bradycardia and chest tightness and dizziness for 3 months.He was diagnosed with dilated cardiomyopathy,heart failure,ventricular tachycardia,atrial fibrillation and atrial flutter.He was not effectively treated after implantable cardioverter defibrillator combined with angiotensin converting enzyme inhibitors(ACEI),P-receptor blockers,aldosterone antagonists and diuretics.Subsequently,he received sacubitril/valsartan therapy at an initial dose of 100 mg,twice daily.After 3-month treatment,the left ventricular ejection fraction(LVEF) was increased from 42% to 54%,the NT-proBNP level was decreased,the six-minute walking distance was prolonged and the symptoms of ventricular premature contraction and ventricular tachycardia were relieved.Compared with ACEI,sacubitirl/valsartan at an initial dose of 100 mg(bid) dose is more effective and safer in the treatment of dilated cardiomyopathy complicated with HFrEF and complex arrhythmia.