目的:射血分数(HFrEF)降低的稳定型心力衰竭患者开始使用沙库巴曲/缬沙坦对液体和钠膨胀反应的影响尚不清楚。
结果:我们已经探索了钠尿的变化,利尿,与沙库巴曲/缬沙坦开始之前相比,HFrEF患者对静脉内液体/钠负荷的充血反应。在基线(沙库必曲/缬沙坦开始前)和开始后2个月和3个月,患者接受了由3小时的三个阶段组成的评估:休息阶段(0-3小时),负荷阶段(3-6小时),其中给予1升静脉林格溶液,以及开始服用呋塞米的利尿剂阶段(6-9小时)。总的来说,216名患者完成了研究。与基线值相比,在沙库必曲/缬沙坦开始后2个月和3个月,患者对林格给药的利尿和利尿显著增加(平均差异:38.8[17.38]毫升,p=0.0040,9.6[2.02]mmol,p分别<0.0001)。与基线相比,液体/钠激发后的充血症状和体征在第2个月和第3个月显著减少。与基线相比,在沙库巴曲/缬沙坦上使用呋塞米后,钠尿增多(9.8[5.13]mmol,p=0.0167)。与基线值相比,随后的随访中体重显着下降(2个月时-0.50[-12.7,7.4]kg,3个月时为-0.75[-15.9,7.5]kg;两者p<0.0001)。
结论:在HFrEF患者中开始使用沙库巴曲/缬沙坦与利钠尿的改善有关,利尿,和体重减轻和更好的临床适应潜在的减充血应激源。
OBJECTIVE: The effects of initiating sacubitril/valsartan in patients with stable heart failure with reduced ejection fraction (HFrEF) on response to fluid and sodium expansion are unknown.
RESULTS: We have explored changes in natriuresis, diuresis, and congestion in response to the administration of intravenous fluid/sodium load in patients with HFrEF before as compared to after the initiation of sacubitril/valsartan. At baseline (before sacubitril/valsartan initiation) and 2 and 3 months after the initiation, patients underwent an evaluation that consisted of three phases of 3 h: the rest phase (0-3 h), the load phase (3-6 h) in which 1 L of intravenous Ringer solution was administered, and the diuretic phase (6-9 h) at the beginning of which furosemide was administered. Overall, 216 patients completed the
study. In comparison to baseline values, at 2 and 3 months after sacubitril/valsartan initiation, patients\' diuresis and natriuresis in response to Ringer administration significantly increased (mean difference: 38.8 [17.38] ml, p = 0.0040, and 9.6 [2.02] mmol, p < 0.0001, respectively). Symptoms and signs of congestion after the fluid/sodium challenge were significantly decreased at months 2 and 3 compared to baseline. Compared to baseline, there was also an increment of natriuresis after furosemide administration on sacubitril/valsartan (9.8 [5.13] mmol, p = 0.0167). There was a significant decrease in body weight in subsequent visits when compared to baseline values (-0.50 [-12.7, 7.4] kg at 2 months, and -0.75 [-15.9, 7.5] kg at 3 months; both p < 0.0001).
CONCLUSIONS: The initiation of sacubitril/valsartan in HFrEF patients was associated with improvements in natriuresis, diuresis, and weight loss and better clinical adaptation to potentially decongestive stressors.