沙库巴曲缬沙坦治疗射血分数中间值心力衰竭患者的疗效及预后

Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with midrange ejection fraction

目的探讨沙库巴曲缬沙坦治疗射血分数中间值心力衰竭(HFmrEF)患者的临床疗效及对预后的影响。方法106例HFmrEF患者随机分为观察组和对照组(n=53),对照组行常规抗心衰治疗,将观察组常规治疗中的血管紧张素转化酶抑制药(ACEI)/血管紧张素Ⅱ受体拮抗药(ARB)替换为沙库巴曲缬沙坦,比较2组患者治疗1、3、6个月后N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)、左室舒张末内径(LVEDD)变化,以心血管死亡或心衰再住院为终点事件,采用Kaplan-Meier生存曲线法比较2组患者治疗6个月内累积无心血管死亡生存率、无心衰再住院生存率及无终点事件生存率。结果2组患者治疗后1、3、6个月NT-proBNP和LVEDD均呈下降趋势,LVEF呈上升趋势,不同时间点间比较差异显著(P时间<0.05),且观察组变化幅度大于对照组(P交互<0.05),2组间比较差异显著(P组间<0.05)。观察组6个月累积无心血管死亡生存率与对照组比较无显著差异(92.1%vs.90.3%,P=0.492),观察组累积无心衰再住院生存率(82.4%vs.63.0%,P=0.034)和无终点事件生存率(74.4%vs.53.1%,P=0.025)显著高于对照组。结论沙库巴曲缬沙坦能有效逆转HFmrEF患者心室重构,改善心功能,并可改善患者临床预后。

AIM To investigate the clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with midrange ejection fraction(HFmrEF).METHODS One hundred and six HFmrEF patients were randomly divided into control group and observation group(n=53 in each).Patients in the control group received routine treatment of anti-heart failure,while patients in the observation group used sacubitril-valsartan instead of angiotensin-converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB).The changes of N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)in both groups were compared and analyzed after 1,3 and 6 months treatment.The end point was cardiovascular death or hospitalization for worsening heart failure.The cardiovascular mortality free survival rate,worsening heart failure rehospitalization free survival rate and event-free survival rate between two groups were compared by Kaplan-Meier survival curve method.RESULTS At 1,3 and 6 months after treatment,NT-proBNP and LVEDD showed a downward trend,and LVEF showed an upward trend in both groups,and there were significant differences at different time points(Ptime<0.05).The change in the observation group was greater than those in the control group(Pinteraction<0.05),and the difference between the two groups was significant(Pgroup<0.05).There was no significant difference between the observation group and the control group in the cardiovascular mortality free survival rate(92.1% vs.90.3%,P=0.492).The worsening heart failure rehospitalization free survival in the observation group(82.4% vs.63.0%,P=0.034)and end-point event-free survival rate(74.4% vs.53.1%,P=0.025)were significantly higher than those in the control group.CONCLUSION Sacubitril-valsartan can effectively reverse ventricular remodeling,improve cardiac function and clinical prognosis in treating HFmrEF patients.