沙库巴曲缬沙坦治疗心血管疾病的研究进展

沙库巴曲缬沙坦是首个血管紧张素受体脑啡肽酶抑制剂,可同时抑制脑啡肽酶和阻断血管紧张素受体。《中国心力衰竭诊断和治疗指南2018》对沙库巴曲缬沙坦作了超越欧洲和美国指南的Ⅰ类推荐。2021年美国食品和药品管理局将沙库巴曲缬沙坦批准用于治疗射血分数正常的心力衰竭患者。大量研究显示沙库巴曲缬沙坦在心力衰竭、心肌梗死、心律失常、高血压、慢性肾脏病和糖尿病患者中均发挥有益作用。本文综述了沙库巴曲缬沙坦治疗心血管疾病及其相关疾病的应用进展。     

沙库巴曲缬沙坦在心力衰竭治疗中的研究进展

心力衰竭是各类心脏疾病的终末阶段,既往尽管使用了临床指南推荐的治疗,心力衰竭患者的愈后仍欠佳。血管紧张素受体-脑啡肽酶抑制剂沙库巴曲缬沙坦是一种新型的治疗心力衰竭药物,因其卓越的疗效,越来越受到人们关注,现就沙库巴曲缬沙坦作用机制、临床研究结果、临床指南推荐及使用方案等方面做一阐述。     

沙库巴曲/缬沙坦在心血管疾病治疗中的研究进展

心血管疾病已经成为威胁全人类健康的严重疾病之一,尽管治疗性药物众多,但其发病率及死亡率仍较高,亟需研发新型药物。沙库巴曲/缬沙坦是一种新型的神经内分泌抑制剂,具有高选择性抑制血管紧张素受体和脑啡肽酶的双重作用,是近年来心血管病治疗领域的重要进展之一。本文就沙库巴曲/缬沙坦在心血管疾病治疗中的作用作一综述。     

沙库巴曲缬沙坦治疗慢性心力衰竭的研究与应用

心力衰竭(heart failure,HF)是指各种心脏疾患导致心脏负荷增加和心输出量下降,诱发肺水肿、体循环淤血、水钠潴留,临床表现为呼吸困难、下肢浮肿、纳差乏力等症状体征.延缓HF进程、提高生活质量是临床对慢性心力衰竭患者的治疗目标.神经体液机制是慢性心力衰竭的主要代偿机制,涉及交感神经系统、肾素-血管紧张素-醛固...     

沙库巴曲/缬沙坦治疗慢性心力衰竭的疗效与安全性分析

目的探讨沙库巴曲/缬沙坦治疗心力衰竭的临床疗效和安全性。方法选择在本院就诊的心力衰竭患者186例,所有患者在原治疗基础上,接受较低初始剂量的沙库巴曲/缬沙坦治疗,105例(56%)患者初始剂量为每次50mg,2次/d;72例(39%)患者初始剂量为每次25mg,2次/d;9例(5%)患者初始剂量为12.5mg,2次/d,治疗(183±85)d。分析评估治疗前后患者症状、住院次数、左心室重构、血压、心率、肾功能、血钾的变化。结果随访(32±24)d,患者纽约心功能分级显著降低(平均下降0.68,P<0.01)。在相同时间段内(142±97)d,因心力衰竭住院次数较用药前明显减少[治疗前(0.84±0.55)次,治疗后(0.41±0.64)次,P<0.01]。随访中位数196d,左心室射血分数明显改善[(0.36±0.08)比(0.40±0.09),P<0.01],左心室舒张末期内径和左心室收缩末期内径显著缩小[(63±7)mm比(61±8)mm,P<0.01;(52±7)mm比(49±9)mm,P<0.05]。使用沙库巴曲/缬沙坦对患者血压、心率、肾功能和血钾均无明显影响(均P>0.05)。结论对于慢性心力衰竭患者,沙库巴曲/缬沙坦是安全的,并能在短时间内改善心功能,减少住院次数和改善左心室重构。     

沙库巴曲缬沙坦的临床应用及其潜在作用

沙库巴曲缬沙坦即血管紧张素受体脑啡肽酶抑制剂(ARNI),是近年来心力衰竭领域的研究热点。多项研究显示该药可明显降低心力衰竭患者的住院率和死亡率,并对多种心血管疾病有良好获益。本文简述了沙库巴曲缬沙坦在心力衰竭、高血压、急性心肌梗死、糖尿病、心脏代谢综合征和肾功能不全等疾病中的相关研究进展,进一步表明沙库巴曲缬沙坦现已不仅局限于射血分数降低的心力衰竭的临床应用,而是对多种心血管疾病甚至非心血管疾病均有潜在的有益作用。     

心力衰竭治疗药物的新变革—沙库巴曲缬沙坦

心力衰竭是一项极其重要的危害人类健康的全球性公共卫生问题,是心血管疾病发生发展的终末阶段,其发病率、再住院率及死亡率在逐年不断的增长,这使得进一步开发更为有效的新型心力衰竭治疗药物迫在眉睫,而具有血管紧张素受体脑啡肽酶抑制剂双重作用机制的沙库巴曲缬沙坦的上市为心衰患者的治疗带来了新的变革。     

沙库巴曲缬沙坦治疗难治性心力衰竭患者疗效及安全性的Meta分析

目的 比较沙库巴曲缬沙坦(LCZ696)与血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)治疗难治性心力衰竭(RHF)患者的疗效和安全性,为临床提供参考依据.方法 通过检索Pubmed,Embase,Web of science,Cochrane,CBM,知网等数据库中已发表的中英文随机对照研究(R...     

沙库巴曲缬沙坦治疗心房颤动合并心力衰竭的研究进展

心力衰竭（心衰）和心房颤动（房颤）是两大高发病率和高死亡率的心血管疾病。这两种疾病常共存,且彼此影响相互促进,加速疾病进展,导致患者脑卒中风险、全因死亡率增加,降低患者生活质量。近年来沙库巴曲缬沙坦在治疗心力衰竭、预防心室重构等领域取得重大进展。临床专家进一步探索了其在治疗心衰合并房颤方面的作用,本文对相关研究进展进行综述。     

Sacubitril/Valsartan Off-Label Uses for Heart Failure

Sacubitril/valsartan is an angiotensin receptor/neprilysin inhibitor that the Food and Drug Administration has indicated to reduce the risk of cardiovascular hospitalization and death in patients with left ventricular ejection fraction below normal and with no specified ejection-fraction cut-off. However, clinically significant patient groups were excluded or minimally represented in sacubitril/valsartan's pivotal clinical trials. Clinicians often encounter scenarios in which a sacubitril/valsartan off-label use may be beneficial, but limited resources are available to evaluate the efficacy and safety in these patients. This state-of-the-art review describes contemporary literature for sacubitril/valsartan Food and Drug Administration off-label indications to help clinicians assess its appropriateness in these selected, clinically important groups of patients: those with acute decompensated heart failure, acute coronary syndrome, peripartum cardiomyopathy, chemotherapy-induced cardiomyopathy, adult congenital heart disease, cardiomyopathy in dialysis patients, right ventricular failure, or durable left ventricular assist device.     

Use of Sacubitril/Valsartan in heart failure with reduced ejection fraction

Background Angiotensin receptor and neprilysin inhibition(ARNI) has been shown to reduce cardiovascular mortality. However, there is a paucity of real-world data in the effects of ARNI in heart failure patients with reduced ejection fraction(HFr EF). Methods We included 225 consecutive HFr EF patients receiving combined sacubitril/valsartan administration and standard HF treatment(Group A) and 550 consecutive HFr EF patients receiving only the standard HF treatment(Group B) from January 2016 to January 2018. Primary outcome was death from cardiovascular causes or first unplanned hospitalization for HF. Results Thirty-three deaths or first unplanned hospitalization for HF occurred in Group A(14.7%) and 102 in Group B(22.7%) with 0.56 hazard ratio(HR), and 95% confidence interval(CI, 0.491-0.867; P=0.001) during a follow-up of 12 month. Moreover, escalation of sacubitril/valsartan(89 cases, 39.6%) was associated with the best clinical outcomes(P0.001). But,the patients with severe hypotension and baseline SBP less than 100 mm Hg in both groups had similar primary outcome. Conclusions Sacubitril/valsartan has beneficial effect on HFr EF patients and the effect enhances when higher dose is given.[S Chin J Cardiol 2019;20(4):252-257]     

Adropin与心血管疾病关系的研究进展

Adropin是一种分泌性蛋白,2008年由Kumar等首次在下丘脑性肥胖小鼠肝脏中发现。它由能量平衡相关基因(Enho)编码,是新的维持能量动态平衡的调节多肽。目前研究表明,adropin与肥胖、糖尿病、代谢综合征、脑卒中、高血压、冠心病、心力衰竭等密切相关,本文就adropin在心血管系统方面的研究情况做一综述。     

circRNA在心血管疾病中的研究进展

环状RNA（circRNA）是长链非编码RNA（lncRNA）家族的一员,具有闭环结构,因此比其它线性非编码RNA具有更高的稳定性。随着高通测序技术的出现和生物信息学的发展,大量circRNA在细胞内外、血液、唾液等中被检测出。已有研究证实circRNA与人动脉粥样硬化,心肌梗死,心力衰竭等心血管疾病的发生发展相关,可能成为疾病诊断更为理想的生物标志物。本文就环状RNA在心血管疾病中的分子机制最新研究进展进行综述。     

Sacubitril/Valsartan: From Clinical Trials to Real-world Experience

Purpose of review

Compared to enalapril, use of angiotensin-receptor blocker and neprilysin inhibitor sacubitril/valsartan to treat patients with heart failure and reduced ejection fraction (HFrEF) is associated with substantial reductions in both cardiovascular mortality and heart failure progression. The purpose of this review is to discuss the real-world experience of sacubitril/valsartan.

Recent findings

In the years following the publication of the landmark PARADIGM-HF trial in 2014 and its subsequent FDA approval, a growing evidence base supports the safety and efficacy of sacubitril/valsartan in a broad spectrum of patients with HFrEF. Updated clinical practice guidelines have embraced the use of sacubitril/valsartan in preference to ACE inhibitors or ARBs in selected patients.

Summary

In this review, we highlight the clinical trials that led to these key updates to clinical guidelines, offer practical strategies for patient selection and utilization in clinical practice, and identify important areas of uncertainty that require future research.

     

Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation

Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for vasoplegia.