同时使用阿菲卡门和迪索皮拉米德治疗症状阻塞性多动性心肌病
Ahmad Masri1, Martin S Maron2, Theodore P Abraham3
1Oregon Health and Science University, Portland, Oregon, USA.
JACC. Heart failure
|April 26, 2025
概括
阿菲卡门与迪索皮拉米德结合使用,安全改善了阻塞性多变性心肌病 (oHCM) 的症状和阻塞. 迪索皮拉米德的停用没有影响aficamten的疗效,这表明它可以在oHCM患者中断aficamten.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 迪索皮拉米德 (disopyramide) 由于其负面无otropic 效应,一直是阻塞性多变性心肌病 (oHCM) 的长期治疗方法.
- 选择性心脏肌肉蛋白抑制剂Aficamten通过直接降低肌肉蛋白-动氨酸相互作用和超收缩性提供了一种新方法.
研究的目的:
- 评估将迪索皮拉米德与aficamten结合的安全性和有效性.
- 评估在接受aficamten的有症状的oHCM患者中撤销disopyramide的影响.
主要方法:
- 分析了来自三个临床试验的患者 (红树木-HCM,红杉-HCM,森林-HCM).
- 根据治疗方法定义了四个患者组:迪索皮拉米德加上阿菲卡门提和停药,迪索皮拉米德加上安慰剂,阿菲卡门提加上迪索皮拉米德和停药,以及持续的组合治疗.
- 评估包括左心室外流管 (LVOT) 阻塞,症状 (NYHA类,KCCQ-CSS) 和NT-proBNP水平.
主要成果:
- 通过添加迪索皮拉米德,Aficamten显著降低了LVOT阻塞,改善了症状,并降低了NT-proBNP.
- 停用aficamten导致阻塞和症状的复发.
- 在服用阿菲卡门特时停止使用迪索皮拉米德并没有影响疗效,没有报告任何安全事件或心房动.
结论:
- 阿菲卡门和迪索皮拉米德的联合治疗是安全的,并且在有症状的oHCM患者中耐受良好.
- 单独的阿菲卡门特显示出显著的临床疗效,而迪索皮拉米德的使用可以在不损失益处的情况下停止.
- 阿菲卡门特是oHCM的可行治疗选择,可能允许停止使用迪索皮拉米德.
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