Impact of early in-hospital initiation of sacubitril/valsartan on left ventricular reverse remodelling in acute heart failure.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2025-08-30 DOI:10.1093/ehjcvp/pvaf061

Tomonori Takahashi, Kenya Kusunose, Takumi Imai, Yutaka Furukawa, Taiji Okada, Toshiaki Kadokami, Yumiko Kanzaki, Hisao Matsuda, Kei Mizukoshi, Keisuke Kida, Yuya Matsue, Masataka Sata, Atsushi Tanaka, Koichi Node

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引用次数: 0

Abstract

Aims: The effect of initiating sacubitril/valsartan (Sac/Val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear. This study aimed to assess the impact of Sac/Val on LV remodelling in patients in whom Sac/Val was initiated during AHF hospitalization.

Methods and results: This study was a sub-analysis of the Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy (control). Among the full analysis set of the PREMIER study, this analysis included 206 patients [mean age, 73 years; 64 females (31.1%)], who had available echocardiographic data. The Sac/Val group (n = 94) showed significantly improved LV function and morphological parameters at 8 weeks. Compared with the control group (n = 112), preload-dependent parameters improved significantly, including LV end-diastolic volume index [mean, -5.1 mL/m2; 95% confidence interval (CI), -10.2 to -0.04; P = 0.048] and tricuspid regurgitation peak velocity (mean, -0.17 m/s; 95% CI, -0.31 to -0.03; P = 0.016). In a subgroup analysis stratified by LV ejection fraction (LVEF), a reverse remodelling effect was primarily observed in patients with an LVEF < 40%.

Conclusion: Early Sac/Val initiation after hospitalization for AHF may significantly improve LV function and morphology at 8 weeks, particularly in patients with an LVEF < 40%, supporting its role in LV reverse remodelling.

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急性心力衰竭患者早期入院服用苏比里尔/缬沙坦对左心室反向重构的影响。

目的：急性心力衰竭（AHF）住院期间启动苏比里尔/缬沙坦（Sac/Val）治疗对左心室（LV）重构的影响尚不清楚。本研究旨在评估Sac/Val对AHF住院期间启动Sac/Val的患者左室重构的影响。方法和结果：本研究是血管紧张素- neprilysin抑制住院加重心力衰竭患者（PREMIER）研究项目的一项亚分析，该研究调查了AHF住院期间启动Sac/Val对超声心动图参数的影响，为期8周，与标准肾素-血管紧张素系统抑制剂治疗（对照组）进行比较。在PREMIER研究的完整分析集中，该分析包括206例患者[平均年龄73岁；64名女性（31.1%）]，均有超声心动图资料。Sac/Val组（n = 94）在8周时左室功能和形态学参数明显改善。与对照组（n = 112）相比，预负荷相关参数显著改善，包括左室舒张末期容积指数[平均值，-5.1 mL/m2；95%置信区间（CI）， -10.2 ~ -0.04；P = 0.048]和三尖瓣反流峰值速度（平均值，-0.17 m/s; 95% CI, -0.31 ~ -0.03; P = 0.016）。在一项以左室射血分数（LVEF）分层的亚组分析中，在LVEF < 40%的患者中主要观察到反向重构效应。结论：AHF住院后早期Sac/Val起始可显著改善8周时左室功能和形态，特别是LVEF < 40%的患者，支持其在左室逆向重构中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

10.10

自引率

14.10%

发文量

期刊介绍： The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.