Different left ventricular remodelling patterns and clinical outcomes between non-ischaemic and ischaemic aetiologies in heart failure patients receiving sacubitril/valsartan treatment
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- Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, No. 9, Section 2, Zhongshan N Rd, Zhongshan District, Taipei City, 104 Taiwan
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- Wei-Ru Chiou
- Department of Medicine, Mackay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252 Taiwan
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- Chien-Yi Hsu
- Faculty of Medicine, School of Medicine, National Yang Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112 Taiwan
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- Po-Lin Lin
- Department of Medicine, Mackay Medical College, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252 Taiwan
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- Huai-Wen Liang
- Division of Cardiology, E-Da Hospital, No. 1, Yida Road, Yanchao District Kaohsiung City, 827 Taiwan
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- Fa-Po Chung
- Faculty of Medicine, School of Medicine, National Yang Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112 Taiwan
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- Chia-Te Liao
- Division of Cardiology, Chi-Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710 Taiwan
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- Wen-Yu Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei City, 114, Taiwan
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- Hung-Yu Chang
- Faculty of Medicine, School of Medicine, National Yang Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City, 112 Taiwan
説明
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>Although the beneficial effect of sacubitril/valsartan (SAC/VAL) compared to enalapril was consistent across ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) groups, the PARADIGM-HF study did not analyse the effect of ventricular remodelling on patients with different aetiologies, which may affect clinical treatment outcomes. This study aimed to compare left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>A total of 1576 patients were analysed. Patients were grouped by LVEF changes following SAC/VAL treatment for 8-month period. LVEF improvement ≥15% was defined as ‘significant improvement’, and <5% or worse was classified as ‘lack of improvement’. The primary outcome was a composite of cardiovascular death and unplanned hospitalization for heart failure. Patients with NICM had lower baseline LVEF but improvement was significantly greater comparing to those with ICM (baseline 28.0 ± 7.7% vs. 30.1 ± 7.1%, P < 0.001, LVEF increase of 11.1 ± 12.6% vs. 6.7 ± 10.2%, P < 0.001). The effect of functional improvement of SAC/VAL on NICM patients showed bimodal distribution. Primary endpoints were inversely associated with LVEF changes in NICM patients: adjusted hazard ratio was 0.42 [95% confidence interval (CI) 0.31–0.58, P < 0.001] for NICM patients with significant improvement, and was 1.73 (95% CI 1.38–2.16, P < 0.001) for NICM patients but lack of improvement. Primary endpoints of ICM patients did not demonstrate an association with LVEF changes.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients indicates favourable outcome.</jats:p> </jats:sec>
収録刊行物
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- European Heart Journal - Cardiovascular Pharmacotherapy
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European Heart Journal - Cardiovascular Pharmacotherapy 8 (2), 118-129, 2020-10-29
Oxford University Press (OUP)