1 Introduction Heart failure （HF） is a global health problem with an estimated prevalence of over 5.8 million in the USA and over 23 million worldwide.It represents the most common cause of hospitalization in elderl...1 Introduction Heart failure （HF） is a global health problem with an estimated prevalence of over 5.8 million in the USA and over 23 million worldwide.It represents the most common cause of hospitalization in elderly patients （〉 65 years） and its incidence has a growing trend mainly due to the aging of the population. Neurohumoral activation plays a major role in the pathophysiology. So in consequence, the cornerstone of its medical treatment is based on the inhibition of the renin-angiotensin-aldosterone system （RAAS） and the sympathetic nervous system, According to this, all patients with HF and reduced ejection fraction should be treated with an angiotensin converting enzyme inhibitor （ACEI） or an angiotensin receptor blocker （ARB） plus a beta blocker （BB） and if needed, a mineralocorticoid recep- tor antagonist （MRA）.展开更多
目的通过检索国内外有关LCZ696(沙库巴曲缬沙坦钠)治疗心力衰竭的RCTs,评价LCZ696治疗心力衰竭的有效性与安全性。方法通过Cochrane library、Pubmed、Web of science、CNKI、VIP、万方数据库检索有关LCZ696治疗心力衰竭的文献,根据纳...目的通过检索国内外有关LCZ696(沙库巴曲缬沙坦钠)治疗心力衰竭的RCTs,评价LCZ696治疗心力衰竭的有效性与安全性。方法通过Cochrane library、Pubmed、Web of science、CNKI、VIP、万方数据库检索有关LCZ696治疗心力衰竭的文献,根据纳入排除标准进行文献筛选,采用Cochrane干预措施系统评价手册5.1.0版中的偏倚风险评估工具对纳入研究进行质量评价,所有结局指标均使用RevMan 5.3软件进行meta分析。结果共选入6篇RCTs研究,共计14967例患者被纳入,合并结局指标结果显示,与依那普利和缬沙坦比较,LCZ696治疗后左心室容积指数(LAVI)[WMD=-2.18,95%CI(-3.63,-0.74),P=0.003]、舒张早期二尖瓣最大充盈速度与舒张早期二尖瓣环最大速度比值(E/e')[WMD=-1.01,95%CI(-1.89,-0.12),P=0.03]、病死率[RR=0.89,95%CI(0.83,0.96),P=0.003]、因心力衰竭再住院率[RR=0.83,95%CI(0.78,0.88),P<0.01]下降更明显,而生活质量评分[WMD=1.32,95%CI(0.69,1.95),P<0.01]、症状性低血压发生率[RR=1.46,95%CI(1.34,1.60),P<0.01]升高更为明显。结论LCZ696可以明显降低心力衰竭患者的病死率和再住院率,且不增加肾功能损伤、血管性水肿、高血钾不良事件风险。展开更多
Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for...Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the fast in class angiotensin receptor neprilysin inhibitor （ARNI） since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin Ⅱ receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides （NPs）, bradykinin, endothelin and angiotensin II （Ang-II）. Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-Ⅱ （with opposite biological actions）. So, a combined inhibition of these both systems （Sacubitril / valsartan） may enhance the benefits of NPs effects in HF （natriuresis, diuresis, etc） while Ang-Ⅱ receptor is inhibited （reducing vasoconstriction and aldosterone release）. In a large clinical trial （PARADIGM-HF with 8442 patients）, this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF （compared to enalapril）. This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction.展开更多
文摘1 Introduction Heart failure （HF） is a global health problem with an estimated prevalence of over 5.8 million in the USA and over 23 million worldwide.It represents the most common cause of hospitalization in elderly patients （〉 65 years） and its incidence has a growing trend mainly due to the aging of the population. Neurohumoral activation plays a major role in the pathophysiology. So in consequence, the cornerstone of its medical treatment is based on the inhibition of the renin-angiotensin-aldosterone system （RAAS） and the sympathetic nervous system, According to this, all patients with HF and reduced ejection fraction should be treated with an angiotensin converting enzyme inhibitor （ACEI） or an angiotensin receptor blocker （ARB） plus a beta blocker （BB） and if needed, a mineralocorticoid recep- tor antagonist （MRA）.
文摘目的通过检索国内外有关LCZ696(沙库巴曲缬沙坦钠)治疗心力衰竭的RCTs,评价LCZ696治疗心力衰竭的有效性与安全性。方法通过Cochrane library、Pubmed、Web of science、CNKI、VIP、万方数据库检索有关LCZ696治疗心力衰竭的文献,根据纳入排除标准进行文献筛选,采用Cochrane干预措施系统评价手册5.1.0版中的偏倚风险评估工具对纳入研究进行质量评价,所有结局指标均使用RevMan 5.3软件进行meta分析。结果共选入6篇RCTs研究,共计14967例患者被纳入,合并结局指标结果显示,与依那普利和缬沙坦比较,LCZ696治疗后左心室容积指数(LAVI)[WMD=-2.18,95%CI(-3.63,-0.74),P=0.003]、舒张早期二尖瓣最大充盈速度与舒张早期二尖瓣环最大速度比值(E/e')[WMD=-1.01,95%CI(-1.89,-0.12),P=0.03]、病死率[RR=0.89,95%CI(0.83,0.96),P=0.003]、因心力衰竭再住院率[RR=0.83,95%CI(0.78,0.88),P<0.01]下降更明显,而生活质量评分[WMD=1.32,95%CI(0.69,1.95),P<0.01]、症状性低血压发生率[RR=1.46,95%CI(1.34,1.60),P<0.01]升高更为明显。结论LCZ696可以明显降低心力衰竭患者的病死率和再住院率,且不增加肾功能损伤、血管性水肿、高血钾不良事件风险。
文摘Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the fast in class angiotensin receptor neprilysin inhibitor （ARNI） since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin Ⅱ receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides （NPs）, bradykinin, endothelin and angiotensin II （Ang-II）. Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-Ⅱ （with opposite biological actions）. So, a combined inhibition of these both systems （Sacubitril / valsartan） may enhance the benefits of NPs effects in HF （natriuresis, diuresis, etc） while Ang-Ⅱ receptor is inhibited （reducing vasoconstriction and aldosterone release）. In a large clinical trial （PARADIGM-HF with 8442 patients）, this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF （compared to enalapril）. This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction.
