Objective: 

There is increasing evidence supporting the efficacy of sacubitril/valsartan for treating left heart failure, but few studies have investigated its effects on right ventricular (RV) dysfunction. This study aimed to explore the effects of sacubitril/valsartan on RV dysfunction among patients with heart failure with reduced ejection fraction (HFrEF).

Methods: 

A total of 93 patients with HFrEF with RV dysfunction who were hospitalized from January 2018 through June 2019 were included in this retrospective observational study. All patients received their first sacubitril/valsartan treatment as in patients during the study period. We excluded 11 patients who were lost to follow-up or had incomplete heart echocardiography data. After 6 months of follow-up, we re-evaluated New York Heart Association Functional Classification and performed echocardiography to identify changes in relevant variables after treatment.

Results: 

At baseline, 24% of the patients had an initial sacubitril/valsartan regimen of 12/13 mg twice daily and 76% of the patients had an initial dose of 24/26 mg twice daily. During follow-up, 27% of patients increased their dosage to 49/50 mg twice daily, 68% of patients were taking 24/26 mg twice daily, and 5% of the patients were still taking 12/13 mg twice daily. We found that sacubitril/valsartan treatment was associated with significant improvements in the following RV function indicators: tricuspid annular plane systolic excursion, tricuspid annular s′ peak velocity (S′), RV fractional area change, and pulmonary artery systolic pressure (PASP). Crude linear regression analysis revealed that a tricuspid annular plane systolic excursion improvement was positively correlated with a change in left ventricular ejection fraction (LVEF) and negatively correlated with a change in left ventricular end-systolic volume (LVESV). However, these correlations were nonexistent after adjusting for multiple echocardiographic variables.

Conclusions: 

In patients with RV dysfunction and HFrEF, sacubitril/valsartan may improve RV remodeling. This influence may be independent of left cardiac remodeling.

中文翻译：

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沙库巴曲/缬沙坦治疗射血分数降低的心力衰竭患者的右心室功能障碍：一项真实世界研究

客观的： 

越来越多的证据支持沙库巴曲/缬沙坦治疗左心衰竭的功效，但很少有研究调查其对右心室（RV）功能障碍的影响。本研究旨在探讨沙库巴曲/缬沙坦对射血分数降低心力衰竭（HFrEF）患者右心室功能障碍的影响。

方法： 

这项回顾性观察研究共纳入 93 例 2018 年 1 月至 2019 年 6 月期间住院的伴有右心室功能障碍的 HFrEF 患者。所有患者均与研究期间的患者一样接受首次沙库巴曲/缬沙坦治疗。我们排除了 11 名失访或心脏超声心动图数据不完整的患者。经过 6 个月的随访，我们重新评估纽约心脏协会功能分类，并进行超声心动图检查以识别治疗后相关变量的变化。

结果： 

基线时，24% 的患者初始沙库巴曲/缬沙坦治疗方案为 12/13 mg，每日两次，76% 的患者初始剂量为 24/26 mg，每日两次。随访期间，27%的患者将剂量增加至49/50 mg，每日两次，68%的患者服用24/26 mg，每日两次，5%的患者仍服用12/13 mg，每日两次。我们发现，沙库巴曲/缬沙坦治疗与以下 RV 功能指标的显着改善相关：三尖瓣环平面收缩期偏移、三尖瓣环 s' 峰值速度 (S')、RV 面积变化分数和肺动脉收缩压 (PASP)。粗线性回归分析显示，三尖瓣环平面收缩期偏移的改善与左心室射血分数（LVEF）的变化呈正相关，与左心室收缩末期容积（LVESV）的变化呈负相关。然而，在调整多个超声心动图变量后，这些相关性不存在。

结论： 

对于患有 RV 功能障碍和 HFrEF 的患者，沙库巴曲/缬沙坦可能会改善 RV 重塑。这种影响可能与左心重构无关。