在心力衰竭中使用完善的喷射分数:FINEARTS-HF随机临床试验
Maria A Pabon1, Orly Vardeny2, Muthiah Vaduganathan1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA cardiology
|May 21, 2025
概括
改善心力衰竭喷射率 (HFimpEF) 的患者仍然面临高心血管风险. 芬瑞在HFimpEF患者中显示出一致的治疗益处,显示出更大的绝对风险降低.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有慢性心力衰竭 (HF) 和左心室喷射率 (LVEF) 改善至40%或更高 (HFimpEF) 的患者可能仍然存在残留心血管风险.
- 了解与HFimpEF相关的临床概况和风险对于优化患者管理至关重要.
研究的目的:
- 评估HFimpEF患者对芬的临床特征,残留风险和治疗反应.
- 在一个更大的HF试验中,评估费涅伦在一小组具有LVEF<40%病史的患者中的疗效和安全性.
主要方法:
- 一项随机临床试验的预规定的分析,涉及6001名患有HF和LVEF≥40%的患者 (包括以前LVEF<40%的患者).
- 参与者接受了finerenone (20 mg或40 mg) 或安慰剂.
- 主要终点是心血管死亡和恶化的HF事件的复合.
主要成果:
- 与恒定的LVEF≥40% (21.4对16.0每100个患者年) 相比,患有HFimpEF和LVEF<40% (n=273) 的病史的患者出现了较高的初级复合结局率.
- 在调整后,这种差异在统计学上并不显著 (绝对RR,1.13;95%CI,0.85-1.49).
- 芬瑞的治疗效果在不同组之间是一致的,在HFimpEF亚组中观察到更大的绝对风险降低 (9.2vs2.5每100个患者年). 安全性概况是相似的,尽管低血压在HFimpEF组中更频繁地使用芬.
结论:
- 患有HFimpEF的患者仍然面临心血管事件的高风险,需要持续的管理策略.
- 芬瑞诺在HFimpEF患者中提供了一致的心血管益处,类似于整体HF保存喷射小部分人群.
- 这些发现强调了尽管LVEF有所改善,但在HF患者中持续进行风险评估和治疗的重要性.
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