维立西呱在老年高龄射血分数降低心力衰竭患者中的应用

doi:10.3969/j.issn.1004-583X.2024.12.003

摘要/Abstract

摘要：

目的评估维立西呱治疗老年高龄射血分数降低心力衰竭(heart failure with reduced ejection fraction, HFrEF)的有效性和安全性。方法回顾性分析2023年1月-2024年8月于我院就诊并使用维立西呱治疗的≥75岁HFrEF患者46例。对比治疗前和治疗后3个月的收缩压(SBP)、舒张压(DBP)、心率(HR)、血钾(K⁺)、肌酐、N-末端B型脑钠肽前体、6 min步行试验(6-minute walk test, 6MWT)和堪萨斯城心肌病问卷得分。结果维立西呱治疗3个月后患者SBP、DBP、HR、K⁺和肌酐差异均无统计学意义(P>0.05)。维立西呱治疗3个月后患者N-末端B型脑钠肽前体、6MWT和堪萨斯城心肌病问卷得分均改善,差异有统计学意义(P<0.05)。结论维立西呱对老年高龄HFrEF患者SBP、DBP、HR、K⁺和肾功影响均较小,可改善患者心功能,提高生活质量。

关键词: 心力衰竭, 维立西呱, 老年人, 生活质量

Abstract:

Objective To evaluate the efficacy and safety of vericiguat in the treatment of heart failure with reduced ejection fraction (HFrEF) in elderly patients. Methods A total of 46 HFrEFpatients older than 75 years treated in our hospital from January 2023 to August 2024 were retrospectively recruited for analyses. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), serum potassium (K⁺), creatinine (Cr), N-terminal B-type natriuretic peptide precursor (NT-proBNP), six-minute walking test (6MWT) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores before and 3 months after treatment were compared. Results There were no significant differences in SBP, DBP, HR, K⁺ and Cr between the two groups after 3 months of treatment (P>0.05). NT-proBNP, 6MWT and KCCQ after 3 months of treatment were significantly improved by the treatment of vericiguat (P<0.05). Conclusion Vericiguat has little effects on SBP, DBP, HR, K⁺ and renal function in elderly patients with HFrEF, but improve cardiac function and quality of life.

Key words: heart failure, vericiguat, aged, quality of life

中图分类号:

R541.6

王婷, 柴春艳. 维立西呱在老年高龄射血分数降低心力衰竭患者中的应用[J]. 临床荟萃, 2024, 39(12): 1081-1084.

Wang Ting, Chai Chunyan. Application of vericiguat in elderly patients with heart failure with reduced ejection fraction[J]. Clinical Focus, 2024, 39(12): 1081-1084.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.12.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I12/1081

图/表 3

表1 一般临床资料

Tab. 1 Baseline data

临床资料	数据
年龄(岁)	80.6±4.13
男性[例(%)]	26(56.5)
体质量指数(kg/m²)	19.09±2.37
左心室射血分数(%)	36.37±6.86
纽约心功能分级[例(%)]
Ⅱ	0
Ⅲ	35(76.1)
Ⅳ	11(23.9)
基础疾病[例(%)]
2型糖尿病	23(50.0)
高血压	16(34.8)
房颤	27(58.7)
冠心病	25(54.3)
慢性肾功能不全	38(67.8)
服药情况[例(%)]
螺内酯	37(80.4)
β受体阻滞剂	36(78.3)
ARNI/ACEI/ARB	29(63.0)
SGLT2i	16(34.8)
噻嗪利尿剂	46(100.0)
伊伐布雷定	9(19.6)
服用5种以上药物[例(%)]	35(76.1)
服用10种以上药物[例(%)]	27(58.7)

表2 患者治疗前后SBP、DBP、HR、K+、Cr比较

Tab. 2 Comparison of SBP, DBP, HR, K+, Cr before and after treatment

时间	SBP(mmHg)	DBP(mmHg)	HR(次/min)	K⁺(mmol/L)	Cr(umol/L)
治疗前	112.33±9.13	63.23±7.83	68.80±8.12	4.48±0.51	112.43±47.58
治疗后	110.80±8.13	62.67±5.17	66.70±7.09	4.44±0.32	114.54±53.11
$t$ 值	0.813	0.902	1.103	0.475	-0.613
P值	0.421	0.296	0.263	0.657	0.552

表2 患者治疗前后SBP、DBP、HR、K+、Cr比较

Tab. 2 Comparison of SBP, DBP, HR, K+, Cr before and after treatment

时间	SBP(mmHg)	DBP(mmHg)	HR(次/min)	K⁺(mmol/L)	Cr(umol/L)
治疗前	112.33±9.13	63.23±7.83	68.80±8.12	4.48±0.51	112.43±47.58
治疗后	110.80±8.13	62.67±5.17	66.70±7.09	4.44±0.32	114.54±53.11
$t$ 值	0.813	0.902	1.103	0.475	-0.613
P值	0.421	0.296	0.263	0.657	0.552

表3 维立西呱治疗前后患者NT-proBNP、6MWT和KCCQ得分比较

Tab. 3 Comparison of NT-proBNP, 6MWT and KCCQ score before and after treatment with vericiguat

时间	NT-proBNP(pg/ml)	6MWT(m)	KCCQ得分(分)
治疗前	5456.07±2941.23	180.37±83.57	59.30±12.44
治疗后	3955.63±1770.18	236.31±96.12	65.56±11.23
$t$ 值	6.484	-10.201	-29.513
P值	0.000	0.000	0.000

表3 维立西呱治疗前后患者NT-proBNP、6MWT和KCCQ得分比较

Tab. 3 Comparison of NT-proBNP, 6MWT and KCCQ score before and after treatment with vericiguat

时间	NT-proBNP(pg/ml)	6MWT(m)	KCCQ得分(分)
治疗前	5456.07±2941.23	180.37±83.57	59.30±12.44
治疗后	3955.63±1770.18	236.31±96.12	65.56±11.23
$t$ 值	6.484	-10.201	-29.513
P值	0.000	0.000	0.000

参考文献 17

[1]	Metra M, Teerlink JR. Heart failure[J]. Lancet, 2017, 390(10106):1981-1995. doi: S0140-6736(17)31071-1 pmid: 28460827
[2]	Liao L, Allen LA, Whellan DJ. Economic burden of heart failure in the elderly[J]. Pharmacoeconomics, 2008, 26(6):447-462. doi: 10.2165/00019053-200826060-00001 pmid: 18489197
[3]	Lam CSP, Mulder H, Lopatin Y, et al. Blood pressure and safety events with vericiguat in the VICTORIA trial[J]. J Am Heart Assoc, 2021, 10(22):e021094.
[4]	Martens P, Nuyens D, Rivero-Ayerza M, et al. Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction[J]. Clin Res Cardiol, 2019, 108(10):1074-1082. doi: 10.1007/s00392-019-01440-y pmid: 30788621
[5]	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2021, 42(36):3599-3726. doi: 10.1093/eurheartj/ehab368 pmid: 34447992
[6]	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. J Am Coll Cardiol, 2022, 79(17):e263-421.
[7]	Tromp J, Ouwerkerk W, van Veldhuisen DJ, et al. A systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction[J]. JACC Heart Fail, 2022, 10(2):73-84.
[8]	Kim HM, Hwang IC, Choi W, et al. Combined effects ofARNI and SGLT2 inhibitors in diabetic patients with heart failurewith reduced ejection fraction[J]. Sci Rep, 2021, 11(1):22342.
[9]	Jhund PS, Fu M, Bayram E, et al. Efcacy and safety of LCZ696 (sacubitril-valsartan) according to age: Insights from PARADIGM-HF[J]. Eur Heart J, 2015, 36(38):2576-2584.
[10]	Martinez FA, Serenelli M, Nicolau JC, et al. Efcacy and safety of dapaglifozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF[J]. Circulation, 2020, 141(2):100-111. doi: 10.1161/CIRCULATIONAHA.119.044133 pmid: 31736328
[11]	Filippatos G, Anker SD, Butler J, et al. Efects of empaglifozin on cardiovascular and renal outcomes in heart failure with reduced ejection fraction according to age: A secondary analysis of EMPEROR-Reduced[J]. Eur J Heart Fail, 2022, 24(12):2297-2304. doi: 10.1002/ejhf.2707 pmid: 36194680
[12]	Cherubini A, Oristrell J, Pla X, et al. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure[J]. Arch Intern Med, 2011, 171(6):550-556. doi: 10.1001/archinternmed.2011.31 pmid: 21444844
[13]	Aimo A, Castiglione V, Borrelli C, et al. Oxidative stress and inflammation in the evolution of heart failure: From pathophysiology to therapeutic strategies[J]. Eur J Prev Cardiol, 2020, 27(5):494-510. doi: 10.1177/2047487319870344 pmid: 31412712
[14]	李雪芹, 孙振峰, 涂胜, 等. 冠心病射血分数降低心力衰竭患者预后影响因素分析及预测模型构建[J]. 疑难病杂志, 2024, 23(11): 1318-1324.
[15]	Nakai T, Perl NR, Barden TC, et al. Discovery of IWP-051, a novel orally bioavailable sGC stimulator with once-daily dosing potential in humans[J]. ACS Med Chem Lett, 2016, 24, 7(5):465-469. doi: 10.1021/acsmedchemlett.5b00479 pmid: 27190594
[16]	Boettcher M, Loewen S, Gerrits M, et al. Pharmacodynamic and pharmacokinetic interaction profile of vericiguat: Results from three randomized phase I studies in healthy volunteers[J]. Clin Pharmacokinet, 2021, 60(3):337-351. doi: 10.1007/s40262-020-00935-6 pmid: 33030703
[17]	Voors AA, Mulder H, Reyes E, et al. Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction: Insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial[J]. Eur J Heart Fail, 2021, 23(8):1313-1321.