RESUMEN
BACKGROUND: Malnutrition commonly occurs in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan, which is an AT1 neprilysin inhibitor, has been shown to reduce mortality and hospitalization in patients with HFrEF. However, its effects on nutritional status remain unclear. METHODS: Sacubitril/valsartan was initiated in 164 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition (mean age: 63â±â20 years; 120 males, 60% ischemic cause). The New York Heart Association (NYHA) functional class and nutritional statuses of the patients were evaluated at the switching to AT1 neprilysin inhibitor and at the 6th-month follow-up of the maximum sacubitril/valsartan dose using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and prealbumin. RESULTS: After the sacubutril/valsartan treatment, a significant reduction in the number (%) of malnourished patients was observed according to CONUT (before 47% vs. after 7%, Pâ<â0.001), GNRI (before 39% vs. after 19%, Pâ<â0.001), PNI scores (before 36% vs. after 12%, Pâ=â0.002), and prealbumin (before 41% vs. after 12%, Pâ<â0.001). Also significant changes were observed at the baseline and follow-up in the mean scores of the three different nutritional indexes and prealbumin levels [CONUT: 2.68â±â2.5, 1.02â±â1.0 (Pâ<â0.001); GNRI: 97.1â±â9.7, 101.2â±â5.9 (Pâ<â0.001); PNI: 38.8â±â4.8, 41.6â±â3.7 (Pâ<â0.001); prealbumin: 14.6â±â6.9âmg/dl, 17.1â±â5.2âmg/dl (Pâ<â0.001)]. Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 23% of the patients improved by two NYHA classes, 48% improved by one NYHA class, and 39% remained stable. CONCLUSION: In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both nutritional and functional statuses.
Asunto(s)
Aminobutiratos/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Desnutrición/tratamiento farmacológico , Estado Nutricional/efectos de los fármacos , Inhibidores de Proteasas/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Tetrazoles/uso terapéutico , Función Ventricular Izquierda/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Aminobutiratos/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Compuestos de Bifenilo , Combinación de Medicamentos , Sustitución de Medicamentos , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/fisiopatología , Persona de Mediana Edad , Neprilisina/antagonistas & inhibidores , Evaluación Nutricional , Estudios Prospectivos , Inhibidores de Proteasas/efectos adversos , Recuperación de la Función , Tetrazoles/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , ValsartánAsunto(s)
Aminobutiratos/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos como Asunto , Suplementos Dietéticos , Aprobación de Drogas , Ácido Eicosapentaenoico/análogos & derivados , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores de Proteasas/uso terapéutico , Proyectos de Investigación , Tetrazoles/uso terapéutico , Aminobutiratos/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Compuestos de Bifenilo , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Suplementos Dietéticos/efectos adversos , Combinación de Medicamentos , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Medicina Basada en la Evidencia , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Neprilisina/antagonistas & inhibidores , Inhibidores de Proteasas/efectos adversos , Tetrazoles/efectos adversos , Resultado del Tratamiento , ValsartánRESUMEN
Heart failure is a disease with a high prevalence and incidence. New therapeutic approaches are needed to prevent the onset of heart failure and to reduce the high morbidity and mortality associated with this disease. An optimized therapy of arterial hypertension in patients with risk factors and the use of the SGLT2 inhibitor empagliflozin in type 2 diabetics are proven strategies to prevent heart failure. The therapeutic options in heart failure with preserved ejection fraction are still insufficient. In heart failure with reduced ejection fraction sacubitril/valsartan, the first approved angiotensin receptor-neprilysin inhibitor, is superior to an angiotensin converting enzyme (ACE) inhibitor. Whether digitalis affects the prognosis in heart failure remains unclear; however, serum concentration should be targeted at the lower therapeutic range. Iron supplementation in heart failure with reduced systolic function and iron deficiency improves symptoms and quality of life.