Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) have been shown to prevent left ventricular remodeling and improve outcomes of patients with heart failure (HF). This study aimed to investigate whether the use of ACEi/ARB could be associated with HF with recovered ejection fraction (HFrecEF) in patients with dilated cardiomyopathy (DCM).

We collected individual patient data regarding demographics, echocardiogram, and treatment in DCM between 2003 and 2014 from the clinical personal record, a national database of the Japanese Ministry of Health, Labour and Welfare. Patients with left ventricular ejection fraction (LVEF) < 40% were included. Eligible patients were divided into two groups according to the use of ACEi/ARB. A propensity score matching analysis was employed. The primary outcome was defined as LVEF ≥ 40% at 3 years of follow-up.

Out of 5,955 patients with DCM and LVEF < 40%, propensity score matching yielded 830 pairs. The mean age was 58.8 years, and 1,184 (71.3%) of the patients were male. The primary outcome was observed more frequently in the ACEi/ARB group than in the no ACEi/ARB group (57.0% versus 49.3%; odds ratio 1.36; 95% confidence interval (CI) 1.12-1.65; P = 0.002). Subgroup analysis revealed that the use of ACEi and ARB was associated with recovery of LVEF regardless of atrial fibrillation. The change in LVEF from baseline to 3 years of follow-up was greater in the ACEi-ARB group (14.9% ± 0.6% versus 12.3% ± 0.5%; P = 0.001).

The use of ACEi/ARB is associated with HFrecEF in patients with DCM and reduced LVEF.

血管紧张素转换酶抑制剂 (ACEi) 和血管紧张素 II 受体阻滞剂 (ARB) 已被证明可预防左心室重构并改善心力衰竭 (HF) 患者的预后。本研究旨在探讨在扩张型心肌病 (DCM) 患者中使用 ACEI/ARB 是否与具有恢复射血分数 (HFrecEF) 的 HF 相关。

我们从 2003 年至 2014 年期间从日本厚生劳动省的国家数据库的临床个人记录中收集了有关人口统计学、超声心动图和 DCM 治疗的个体患者数据。包括左心室射血分数 (LVEF) < 40% 的患者。符合条件的患者根据ACEi/ARB的使用情况分为两组。采用倾向得分匹配分析。主要结果定义为随访 3 年时 LVEF ≥ 40%。

在 5,955 名 DCM 和 LVEF < 40% 的患者中，倾向评分匹配产生了 830 对。平均年龄为 58.8 岁，其中 1,184 (71.3%) 名患者为男性。与无 ACEI/ARB 组相比，ACEi/ARB 组的主要结局更频繁地观察到（57.0% 对 49.3%；优势比 1.36；95% 置信区间 (CI) 1.12-1.65；P = 0.002）。亚组分析显示，无论心房颤动如何，ACEi 和 ARB 的使用都与 LVEF 的恢复相关。从基线到随访 3 年，ACEi-ARB 组的 LVEF 变化更大（14.9% ± 0.6% 对 12.3% ± 0.5%；P = 0.001）。

在 DCM 和 LVEF 降低的患者中，ACEi/ARB 的使用与 HFrecEF 相关。