Aims 

The angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) is recommended for the treatment of patients with heart failure in New York Heart Association (NYHA) class II–III and left ventricular ejection fraction (LVEF) 35% or less. We examined the effects of sacubitril/valsartan on cardiac remodeling and their correlation with heart failure duration in patients enrolled in our heart failure clinic from March 2017 to December 2019.

Methods 

Echocardiographic and clinical/laboratory data were collected at baseline and at 6-month and 12-month follow-up visits in 69 patients (age 67 ± 12 years, disease duration 8.4 ± 5.8 years, 93% men).

Results 

At both time points, mean NYHA class, NT-proBNP level, LVEF, LV end-systolic volume, and estimated systolic pulmonary pressure significantly (P < 0.05) improved versus baseline, as did the proportion of patients with diastolic dysfunction grade 3 or functional mitral regurgitation grade 3–4. In the subgroup with mean disease duration less than 8.5 years (n = 40), there was a significant improvement in all variables at both time points; in this group, a recovery of right ventricular function was also seen at the 12-month follow-up. On the contrary, patients with heart failure duration of at least 8.5 years (n = 29) showed only a slight improvement in LVEF and mitral regurgitation at 12 months. There were no significant changes in renal function and/or potassium levels in all patients.

Conclusion 

In patients with a relatively short disease duration, sacubitril/valsartan was associated with a strong favorable remodeling of the left ventricle and improvement in pulmonary circulation.

中文翻译：

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沙库巴曲/缬沙坦治疗的重塑效果是否取决于心力衰竭持续时间？

宗旨 

血管紧张素受体和脑啡肽酶抑制剂 (ARNI)沙库巴曲/缬沙坦(LCZ696) 被推荐用于治疗纽约心脏协会 (NYHA) II-III 级和左心室射血分数 (LVEF) 35% 或以下的心力衰竭患者。我们研究了沙库巴曲/缬沙坦对 2017 年 3 月至 2019 年 12 月在我们心力衰竭诊所登记的患者心脏重构的影响及其与心力衰竭持续时间的相关性。

方法 

69 名患者（年龄 67 ± 12 岁，病程 8.4 ± 5.8 年，93% 男性）在基线和 6 个月和 12 个月的随访时收集了超声心动图和临床/实验室数据。

结果 

在两个时间点，平均 NYHA 分级、NT-proBNP 水平、LVEF、LV 收缩末期容积和估计的收缩期肺压与基线相比显着改善( P < 0.05)，舒张功能障碍 3 级或功能障碍患者的比例也显着改善二尖瓣关闭不全 3-4 级。在平均病程小于 8.5 年（n = 40）的亚组中，两个时间点的所有变量都有显着改善；在该组中，在 12 个月的随访中也观察到右心室功能的恢复。相反，心力衰竭病程至少为 8.5 年的患者（n= 29) 显示 12 个月时 LVEF 和二尖瓣关闭不全仅略有改善。所有患者的肾功能和/或钾水平没有显着变化。

结论 

在病程相对较短的患者中，沙库巴曲/缬沙坦与左心室的强烈有益重塑和肺循环改善有关。