Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial
Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial
复制标题
DOI：
10.1093/eurheartj/ehz240
复制
发表时间：
2019-10-21
影响因子：
39.3
通讯作者：
Braunwald, Eugene
中科院分区：
文献类型：
--
作者：
Morrow, David A.;Velazquez, Eric J.;Braunwald, Eugene
目的探讨心力衰竭（HF）患者血清高敏心肌肌钙蛋白（hsTn）和可溶性ST 2（sST 2）水平的变化与心肌应激的关系。产生环鸟苷3 '5'一磷酸（cGMP），以响应利钠肽受体的激活，降低心脏后负荷和前负荷。我们评估了沙库巴曲/缬沙坦对这些生物标志物的影响，在射血分数降低和急性失代偿性HF（ADHF）的患者。方法和结果PIONEER-HF是一个随机，双盲试验沙库巴曲/缬沙坦与依那普利在ADHF住院患者的血液动力学稳定。我们在基线、1、2（sST 2、cGMP）、4和8周（n = 69 4，所有基线生物标志物）测量了循环hsTnT、sST 2和尿cGMP。确定几何平均值（时间点/基线）的比值，并将其作为沙库巴曲/瓦沙坦与依那普利的比值进行比较。与依那普利相比，沙库巴曲/缬沙坦导致hsTnT和sST 2显著更大的下降。sST 2的这种效应早在第1周就出现了，在第4周时，两者都有显著性差异，hsTnT降低了16%（P <0.05）。
Aims Circulating high-sensitivity cardiac troponin (hsTn) and soluble ST2 (sST2) reflect myocardial stress in patients with heart failure (HF). Production of cyclic guanosine 3'5' monophosphate (cGMP) in response to activation of natriuretic peptide receptors reduces cardiac afterload and preload. We assessed the effects of sacubitril/valsartan on these biomarkers in patients with reduced ejection fraction and acute decompensated HF (ADHF).Methods and results PIONEER-HF was a randomized, double-blind trial of sacubitril/valsartan vs. enalapril in hospitalized patients with ADHF following haemodynamic stabilization. We measured circutating hsTnT, sST2, and urinary cGMP at baseline, 1, 2 (sST2, cGMP), 4, and 8 weeks (n = 69 4 with all baseline biomarkers). Ratios of geometric means (timepoint/baseline) were determined and compared as a ratio for sacubitril/vatsartan vs. enalapril. Compared with enatapril, sacubitril/valsartan led to a significantly greater decline in hsTnT and sST2. This effect emerged as early as 1 week for sST2 and was significant for both at 4 weeks with a 16% greater reduction in hsTnT (P