中低剂量沙库巴曲缬沙坦对射血分数降低的老年心力衰竭病人心室重构和再住院率的影响

doi:10.3969/j.issn.1003-9198.2023.08.018

摘要/Abstract

摘要： 目的评价我国真实世界临床实践中,射血分数降低的老年心力衰竭(HFrEF)病人应用沙库巴曲缬沙坦(ARNI)的安全性和有效性。方法本研究为单中心队列研究,共纳入HFrEF病人215例,其中采用ARNI治疗的为ARNI组(n=110),同期采用血管紧张素转化酶抑制剂(ACEI)或者血管紧张素受体拮抗剂(ARB)进行治疗的为对照组(n=105)。比较2组接受治疗6个月后的超声心动图检测结果和1年内心衰再住院率。结果治疗6个月后,2组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左房内径(LAD)、室性早搏次数(PVCs)均显著降低,LVEF显著提升(P<0.05);ARNI组LVEF较对照组提升更显著(P<0.05)。ARNI组病人1年内心衰再住院率较对照组更低(29.1%比54.3%,P<0.05)。校正了年龄、性别、BMI、房颤、高血压等因素后,Logistic回归分析结果显示,使用ARNI的病人1年内心衰再住院风险仅为使用ACEI/ARB病人的0.23倍(P=0.008)。2组均没有观察到严重的不良反应事件。结论中低剂量沙库巴曲缬沙坦有利于老年HFrEF病人心脏逆向重构,并能够改善左心室收缩和舒张功能,降低心衰再住院风险,且无严重不良反应。

关键词: 沙库巴曲缬沙坦, 射血分数降低的心力衰竭, 心室重构, 再住院

Abstract: Objective To evaluate the safety and efficacy of sacubitril/valsartan in the elderly patients with heart failure with reduced ejection fraction(HFrEF). Methods A total of 215 elderly patients with HFrEF treated with either sacubitril/valsartan(ARNI group, n=110) or angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)(control group, n=105) from September 2017 to September 2019 in our hospital were enrolled in the single-center observational cohort study. The indexes of echocardiography 6 months after treatment and the re-hospitalization rate due to heart failure within 1 year were compared between the two groups. Results After 6 months of treatment, the levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left atrial diameter (LAD), and the beats of premature ventricular contractions (PVCs) in the two groups were significantly decreased, while the level of left ventricular ejection fraction (LVEF) was significantly increased (P<0.05). The level of LVEF in ARNI group was significantly higher than that in the control group (P<0.05). The rate of readmission due to heart failure within 1 year was lower in ARNI group than that in the control group (29.1% vs 54.3%, P<0.05). After adjusting age, sex, body mass index, atrial fibrillation, hypertension and other factors, Logistic regression analysis showed that the risk of re-hospitalization due to heart failure within 1 year in the patients using ARNI was only 0.23 times of that in the patients using ACEI/ARB (P=0.008). No severe adverse event was recorded. Conclusions Low dose sacubitril/valsartan can induce beneficial cardiac reverse remodeling and improve ventricular systolic and diastolic function in the elderly patients with HFrEF without severe adverse effect.

Key words: sacubitril/valsartan, heart failure with reduced ejection fraction, ventricular remodeling, readmission

中图分类号:

R 541.6

胡静雯, 姜婉莹, 霍俊宇, 王岚, 王骁智. 中低剂量沙库巴曲缬沙坦对射血分数降低的老年心力衰竭病人心室重构和再住院率的影响[J]. 实用老年医学, 2023, 37(8): 828-833.

HU Jing-wen, JIANG Wan-ying, HUO Jun-yu, WANG Lan, WANG Xiao-zhi. Effects of medium/low-dose sacubitril/valsartan on cardiac remodeling and readmission in elderly patients with heart failure with reduced ejection fraction[J]. Practical Geriatrics, 2023, 37(8): 828-833.

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