Vnitr Lek 2021, 67(4):212-117 | DOI: 10.36290/vnl.2021.055
Sledování dynamiky klinických a laboratorních markerů chronického srdečního selhání při 12měsíční léčbě sacubitril/valsartanem
- 1 Interní klinika 1. LF UK a ÚVN, Ústřední vojenská nemocnice, Vojenská fakultní nemocnice, Praha
- 2 Oddělení biostatistiky, Státní zdravotní ústav, Praha
Cíl: Léčba sacubitril/valsartanem (S/V) významně zlepšuje kardiovaskulární morbiditu, mortalitu, kvalitu života a prodlužuje přežívání nemocných s chronickým srdečním selháním s redukovanou ejekční frakcí. Cílem studie bylo zhodnotit změny ejekční frakce, NT-proBNP a glomerulární filtrace po 12měsíční léčbě sacubitril/valsartanem.
Klíčová slova: srdeční selhání, renin, angiotensin, natriuretické peptidy, duální inhibice, sacubitril/valsartan, LCZ696.
Monitoring the dynamics of clinical and laboratory markers of chronic heart failure during 12 months of sacubitril/valsartan treatment
Aim: Treatment with sacubitril/valsartan (S/V) significantly improves cardiovascular morbidity, mortality, quality of life and prolongs the survival of chronic heart failure patients with reduced ejection fraction. The aim of the study was to evaluate changes in ejection fraction, NT-proBNP and glomerular filtration after 12 months of sacubitril/valsartan treatment.
Methods: 30 patients (28 men) with chronic heart failure with reduced ejection fraction, functional classes NYHA II-III, EF LK < 40%, NT-proBNP (> 450 ng/l), with glomerular filtration > 0.5 ml/s/1.73 m2, with a potassium < 5.4 mmol/l were classified in the study. S/V treatment was started at systolic blood pressure > 100 mmHg. Ejection fraction, glomerular filtration rate and NT-proBNP values were compared before treatment and after 12 months of S/V treatment. The number of hospitalizations and deaths was also monitored.
Results: During 12 months of S/V treatment there was a significant improvement in left ventricular ejection fraction (median initial 26.3%, after treatment 36.3%, difference 7.5%, p <0.001), there was an improvement in glomerular filtration (median initial 0.90 ml/s, after treatment 0.97 ml/s, difference 0.06 ml/s, p < 0.01) and a significant reduction in NT-proBNP (median initial 1363.0 ng/l, after treatment 647.0 ng/l, difference - 600.0 ng/l, p < 0.001). The NYHA functional class has been improved by I grade in 33.3% of patients, in 63.3% the clinical condition was stationary. Systolic and diastolic blood pressure after 12 months were the same in 50.0% and in 53.3% of patients, respectively. Hospitalization for heart failure was necessary in 5 (16.6%) patients, no deaths occurred. No patient had to discontinue S/V therapy. The maximum dose of S/V 97/103 mg was achieved in 33.3% of patients, the limitation of titration was hypotension.
Conclusion: Sacubitril/Valsartan is an effective, safe, and affordable drug that significantly improves the prognosis of chronic heart failure patients with reduced ejection fraction, improves quality of life, reduces hospitalizations, and prolongs survival.
Keywords: heart failure, renin, angiotensin, natriuretic peptides, dual inhibition, sacubitril/valsartan, LCZ696.
Zveřejněno: 29. červen 2021 Zobrazit citaci
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