«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

28卷

期数:

2022年03期

页码:

229-234

栏目:

心血管疾病专题

出版日期:

2022-05-20

文章信息/Info

Title:

Evaluation of efficacy of sacubitril -valsartan in patients with heart failure in different courses after myocardial infarction

文章编号:

1006-8147(2022)03-0229-06

作者:

陈巧¹; 孙洁¹; 李竹青²; 陈欣³; 卢成志³

（1.天津医科大学一中心临床学院，天津300192；2.南开大学医学院，天津300071；3.天津市第一中心医院心 内科，天津300192）

Author(s):

CHEN Qiao¹; SUN Jie¹; LI Zhu-qing²; CHEN Xin³; LU Cheng-zhi³

（1.The First Central Clinical School，Tianjin Medical University，Tianjin 300192，China；2.The Medicine College of Nankai University， Tianjin 300071，China；3.Department of Cardiology，Tianjin First Central Hospital，Tianjin 300192，China）

关键词:

沙库巴曲缬沙坦; 心肌梗死; 心力衰竭; 回顾性研究; 生存分析

Keywords:

sacubitril/valsartan;  myocardial infarction;  heart failure;  retrospective study;  survival analysis

分类号:

R541.4

DOI:

-

文献标志码:

A

摘要:

目的：回顾性分析比较心肌梗死（MI）后不同病程心力衰竭（心衰）患者应用沙库巴曲缬沙坦（Sacubitril/Valsartan，LCZ696）的 临床疗效是否存在差异。方法： 收集2018 年1 月1 日—2020 年6 月30 日在天津市第一中心医院心内科住院并首次服用 LCZ696 的MI 后心衰患者共150 例，分为并发心衰组，心衰病程≤2 年组和心衰病程＞2 年组，各50 例，以治疗后3、6、12 个月 为时间节点进行为期1 年的回访，观察心脏超声指标变化和生存情况，并用Cox 回归分析影响疗效的因素。结果：3组患者左心 室射血分数（LVEF）（F=62.111，P＜0.01）和舒张末期内径（LVEDD）（F=38.444，P＜0.01）分别呈逐渐上升和下降趋势，其中在并发 心衰组的变化最显著，组间差异存在统计学意义。3 组间累积无终点事件生存率（90.0%、57.8%、35.3%）有统计学意义（字2= 32.754，P＜0.01）。Cox 回归分析发现长心衰病程患者终点事件发生的风险大（HR=10.407，95%CI：3.957~27.371，P<0.001）。结论： MI 后心衰患者早期启用LCZ696 更有利于改善左室重构，无事件生存率更高。

Abstract:

Objective: To retrospectively analyze and compare the clinical efficacy of sacubitril-valsartan（LCZ696）in patients with different course of heart failure（HF）after myocardial infarction（MI）. Methods: A total of 150 patients with HF after MI who were hospitalized in the Department of Cardiology，Tianjin First Central Hospital from January 1，2018 to June 30，2020 and firstly administered with LCZ696 were collected. They were divided into concurrent HF group，HF duration≤2 years group and HF duration > 2 years group，with 50 cases in each group. A one-year return visit was conducted at 3，6 and 12 months after treatment to observe the changes of cardiac ultrasound parameters and prognosis. Cox regression analysis was used to analyze the factors affecting the efficacy. Results: Left ventricular ejection fraction（LVEF）（F=62.111，P<0.01）and left ventricular end-diastolic diameter（LVEDD）（F=38.444，P<0.01）showed a gradually increasing and decreasing trend in the three groups，respectively. The difference between the three groups was statistically significant，and the most significant change was observed in concurrent HF group. The cumulative end-point free survival rates （90.0%，57.8%，35.3%） among the three groups were statistically significant（字2=32.754，P < 0.01）. Cox regression analysis showed that patients with long course of HF after MI had a higher risk of end-point events（HR=10.407，95%CI：3.957~27.371，P<0.001）. Conclusion: Early initiation of LCZ696 in patients with HF after MI is more beneficial to improving left ventricular remodeling，and the event -free survival rate is higher.

参考文献/References:

[1] DOCHERTY K F，VADUGANATHAN M，SOLOMON S D，et al. Sacubitril/valsartan: neprilysin inhibition 5 years after paradigm-hf [J]. JACC Heart Fail，2020，8（10）：800-810.
[2] JERNBERG EOO T J，HAMILTON E H，LINDMARK K L，et al. Prevalence and prognostic impact of left ventricular systolic dys － function after acute myocardial infarction[J]. Eur Heart J，2020，41 （Suppl2）：ehaa946.1796.
[3] PFEFFER M A，CLAGGETT B，LEWIS E F，et al. Angiotensin receptor- neprilysin inhibition in acute myocardial infarction[J]. N Engl J Med，2021，385（20）：1845-1855.
[4] WANG H，FU X. Effects of sacubitril/valsartan on ventricular remodeling in patents with left ventricular systolic dysfunction following acute anterior wall myocardial infarction[J]. Coron Artery Dis，2021， 32（5）：418-426.
[5] MCMURRAY J J，PACKER M，DESAI A S，et al. Angiotensin - neprilysin inhibition versus enalapril in heart failure [J]. N Engl J Med，2014，371（11）：993-1004.
[6] WACHTER R，SENNI M，BELOHLAVEK J，et al. Initiation of sacubitril/ valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge：primary results of the ran － domised transition study[J]. Eur J Heart Fail，2019，21（8）：998- 1007.
[7] VELAZQUEZ E J，MORROW D A，DEVORE A D，et al. An － giotensin-neprilysin inhibition in acute decompensated heart failure[ J]. N Engl J Med，2019，380（6）：539-548.
[8] PASCUAL-FIGAL D，WACHTER R，SENNI M，et al. Nt-probnp response to sacubitril/valsartan in hospitalized heart failure patients with reduced ejection fraction：transition study[J]. JACC Heart fail， 2020，8（10）：822-833.
[9] DEVORE A D，HILL C L，THOMAS L，et al. Patient，provider，and practice characteristics associated with sacubitril/valsartan use in the united states[J]. Circ Heart Fail，2018，11（9）：e005400.
[10] DOCHERTY K F，CAMPBELL R T，BROOKSBANK KJM，et al. Effect of neprilysin inhibition on left ventricular remodeling in patients with asymptomatic left ventricular systolic dysfunction late after myocardial infarction[J]. Circulation，2021，144（3）：199-209.
[11] KHAN M S，FELKER G M，PI譙A I L，et al. Reverse cardiac remodeling following initiation of sacubitril/valsartan in patients with heart failure with and without diabetes [J]. JACC Heart fail，2021，9（2）: 137-145.
[12] SHEN J，FAN Z，SUN G，et al. Sacubitril/valsartan（lcz696）reduces myocardial injury following myocardial infarction by inhibiting nlrp3 induced pyroptosis via the tak1/jnk signaling pathway[J]. Mol Med Rep，2021，24（3）:676.
[13] LEE S，HWANG H S，SONG N，et al. Effect of neprilysin inhibition for ischemic mitral regurgitation after myocardial injury[J]. Int J Mol Sci，2021，22（16）:8598.
[14] MURPHY S P，PRESCOTT M F，MAISEL A S，et al. Association between angiotensin receptor -neprilysin inhibition，cardiovascular biomarkers，and cardiac remodeling in heart failure with reduced ejection fraction[J]. Circ Heart Fail，2021，14（6）:e008410.
[15] POPOVIC D，DJORDJEVIC T，JAKOVLJEVIC D，et al. N-terminalpro- brain natriuretic peptide dynamics during effort phenotypes ischemic heart failure and determines prognosis regardless of ejection fraction[J]. Peptides，2020，129:170315.
[16] ZILE M R，CLAGGETT B L，PRESCOTT M F，et al. Prognostic implications of changes in n-terminal pro-b-type natriuretic peptide in patients with heart failure [J]. J Am Coll Cardiol，2016，68（22）: 2425-2436.
[17] MOON M G，HWANG I C，CHOI W，et al. Reverse remodelling by sacubitril/valsartan predicts the prognosis in heart failure with reduced ejection fraction[J]. ESC Heart Fail，2021，8（3）:2058-2069.
[18] WACHTER R，KLEBS S，BALAS B，et al. Heart failure signs and symptoms，hospital referrals，and prescription patterns in patients receiving sacubitril/valsartan in primary care and cardiologist settings in germany[J]. ESC heart fail，2020，7（5）:2318-2330.
[19] BERG D D，BRAUNWALD E，DEVORE A D，et al. Efficacy and safety of sacubitril/valsartan by dose level achieved in the pioneerhf trial[J]. JACC Heart fail，2020，8（10）:834-843.
[20] KIDO K，BIANCO C，CACCAMO M，et al. Evaluating sacubitril/valsartan dose dependence on clinical outcomes in patients with heart failure with reduced ejection fraction[J]. Ann Pharmacother，2021， 55（9）:1069-1075.

相似文献/References:

[1]劳 咪,李广平,张 跃,等.ST段抬高型心肌梗死患者梗死相关动脉自发再通的相关因素[J].天津医科大学学报,2014,20(03):201.
　LAO Mi,LI Guang-ping,ZHAND Yue,et al.Related factors of spontaneous reperfusion of infarction related artery in patients with acute ST-segment elevation myocardial infarction[J].Journal of Tianjin Medical University,2014,20(03):201.
[2]马艺杰,李 超,卢成志.去肾交感神经术对心梗犬下丘脑Ang(1-7) 及酪氨酸羟化酶的影响[J].天津医科大学学报,2016,22(01):9.
　MA Yi-jie,LI Chao,LU Cheng-zhi.Effect of renal denervation on hypothalamus angiotensin(1-7) and tyrosine hydroxylase in myocardial infarction dogs[J].Journal of Tianjin Medical University,2016,22(03):9.
[3]徐凯月,孟祥雪,黄 传,等.间歇性低氧干预提高心梗大鼠心功能和运动耐量[J].天津医科大学学报,2019,25(05):459.
　XU Kai-yue,MENG Xiang-xue,HUANG Chuan,et al.Intermittent hypoxia intervention improves cardiac function and exercise tolerance of rats with myocardial infarction[J].Journal of Tianjin Medical University,2019,25(03):459.
[4]叶文群,郭牧,梁海清,等.沙库巴曲缬沙坦对比雷米普利对接受PCI治疗的AMI患者早期心室重构的影响：一项单中心倾向性匹配分析[J].天津医科大学学报,2023,29(02):113.
　YE Wen-qun,GUO Mu,LIANG Hai-qing,et al.Effect of sacubitril/valsartan versus ramipril on early myocardial remodeling in AMI patients undergoing PCI：a propensity matching analysis in a single center[J].Journal of Tianjin Medical University,2023,29(03):113.
[5]陶文岐,姚朱华.达格列净或沙库巴曲缬沙坦对急性心肌梗死大鼠的作用机制探讨[J].天津医科大学学报,2023,29(04):406.
　TENG Jie,CHEN Ye-gangTAO Wen-qi.Exploring the mechanism of protective effect of dapagliflozin or sacubitril/valsartan in rats with acute myocardial infarction[J].Journal of Tianjin Medical University,2023,29(03):406.

备注/Memo

备注/Memo:

基金项目国家自然科学基金（81970303）
作者简介:陈巧（1995-） ，女，硕士在读，研究方向：心血管疾病；
通 信作者：卢成志，E-mail：Luchengzhi2021@163.com。

常用功能

更新日期/Last Update: 2022-06-01