在Sacubitril/ Valsartan治疗后改善左心室功能的患者的最佳维持策略
Yoonjee Park1, Minjung Bak2,3, Heayoung Shin2
1Department of Cardiology, Bucheon Sejong Hospital, 28, Bucheon-si 14754, Republic of Korea.
Medicina (Kaunas, Lithuania)
|August 28, 2025
概括
对于心力衰竭和改善排泄率 (HFimpEF) 的患者来说,维持萨库比特里尔/ 瓦尔萨坦 (S/ V) 或转换为宁- 血管激素系统阻断剂 (RASB) 是至关重要的. 停用这两种疗法显著增加心力衰竭复发的风险.
科学领域:
- 心脏病学
- 药理学
背景情况:
- 在心力衰竭 (HF) 中左心室喷射分数 (LVEF) 改善后的最佳药理管理尚未确立.
- 患有HF和改善EF (HFimpEF) 的患者代表需要特定治疗策略的越来越多的人群.
研究的目的:
- 根据维持sacubitril/ valsartan (S/ V) 与转换为renin- angiotensin系统阻断剂 (RASB) 的 HFimpEF 患者的临床结果进行比较.
- 评估停止S/ V和RASB对该患者队列中HF复发的影响.
主要方法:
- 在S/ V治疗后恢复LVEF的354名患者的回顾性分析.
- 患者分为:继续S/ V (n=294),转换为RASB (n=47),或停止两者 (n=13).
- 主要终点:HF复发 (2倍NT-proBNP增加>400 pg/dL);次要终点:NT-proBNP水平变化.
主要成果:
- 在S/V维护和RASB切换组之间,HF复发或NT-proBNP水平没有显著差异.
- 与维持组 (10. 6% - 16. 3%; p=0. 001) 相比,停止S/ V和RASB与显著更高的HF复发率相关.
- 在停止两种治疗的组中,NT-proBNP水平呈现出更明显的增加.
结论:
- 用另一种RASB替换S/ V是维持HFimpEF患者缓解的安全策略.
- 在HFimpEF中停止所有指导药物治疗会显著增加复发的风险.
- 需要进行前性研究来证实这些发现并优化长期管理.
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