Turkiye Klinikleri Cardiovascular Sciences

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Sakubitril/Valsartan Kullanımının Kliniğe ve Laboratuvar Bulgularına Etkilerinin, İskemik ve Non-İskemik Kalp Yetersizliği Hastalarında Karşılaştırmalı Olarak Değerlendirilmesi
The Effect of Sacubitril/Valsartan on Clinical and Laboratory Findings Comparatively in Ischemic and Non-Ischemic Heart Failure Patients
Tuğba KEMALOĞLU ÖZa, Tarık KIVRAKb, Tayfun GÜROLc, Regayip ZEHİRd, Özer SOYLUc, Bahadır DAĞDEVİRENc
aKardiyoloji Kliniği, İstanbul Medipol Üniversitesi Çamlıca Hastanesi,
bKardiyoloji ABD, Fırat Üniversitesi Hastanesi,
cKardiyoloji Kliniği, Bahçeşehir Üniversitesi Göztepe Medical Park Hastanesi,
dKardiyoloji Kliniği, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(3):135-42
doi: 10.5336/cardiosci.2019-66657
Article Language: TR
Full Text
ÖZET
 Amaç: Sakubitril/valsartan tedavisinin, enalaprile kıyasla düşük ejeksiyon fraksiyonlu kalp yetersizliği (DEF-KY) hastalarında hastaneye yatış ve mortalite riskini azalttığı ve yaşam kalitesini artırdığı gösterilmiştir, ancak bugüne kadar ülkemizde yapılmış, sakubitril/valsartanın klinik bulgulara ve laboratuvar sonuçlarına olan etkilerini gösteren çalışma bulunmamaktadır. Biz çalışmamızda, sakubitril/ valsartan tedavisinin kliniğe ve laboratuvar bulgularına olan etkilerini hem iskemik hem de non-iskemik DEF-KY hastalarında karşılaştırmalı olarak araştırmayı hedefledik. Gereç ve Yöntemler: Çalışmamıza, 18 yaşından büyük, KY kılavuzlarına göre sakubitril/valsartan tedavisi başlama endikasyonu olan hastalar dâhil edildi. Tüm hastalardan tedavi başlamadan önce ve tolere edilebilen maksimal doz sakubitril/valsartan tedavisinin 6. ayında olmak üzere iki kez ayrıntılı öykü alındı, tüm sistem fizik muayene yapıldı ve elektrokardiyogram çekildi. Venöz kanda sodyum (Na), potasyum (K), kreatinin ve NT-ProBNP düzeylerine bakıldı. Tedavi öncesi ve sonrası bulgular karşılaştırıldı. Bulgular: Çalışmaya başlangıçta 150 hasta katıldı. Bu hastalardan 19'u takip süresini tamamlayamadığı için çalışma dışı bırakıldı ve toplamda 71'i iskemik, 56'sı ise non-iskemik KY hastası olmak üzere 127 hasta (%27,6'sı kadın) çalışmaya dâhil edildi. Her iki grupta da sistolik ve diyastolik kan basıncı, dakikadaki kalp hızı, NT-proBNP ve Na düzeyi ve haftalık furosemid ihtiyacında istatistiksel olarak anlamlı azalma gözlendi. Glomerüler filtrasyon hızı (GFH)'nda anlamlı değişiklik olmazken, kreatinin ve potasyum (K) düzeylerinde istatistiksel olarak anlamlı artış tespit edildi. Sonuç: Bu çalışmanın sonuçları göstermiştir ki sakubitril/valsartan, hem iskemik hem de non-iskemik DEF-KY'de benzer etkiler yaratmakta, her iki grupta da hastaların laboratuvar ve klinik bulgularında belirgin düzelme, semptomlarında rahatlama, haftalık furosemid ihtiyacında azalma ve kalp hızında düşüş sağlamaktadır. Bununla birlikte, yan etkiler olarak semptomatik hipotansiyon, hiperpotasemi ve GFH düşüşü açısından dikkatli olunmalıdır.

Anahtar Kelimeler: Kalp yetersizliği; LCZ 696; Kalp yetersizliği, sistolik; tedavi sonucu
ABSTRACT
 Objective: Sacubitril/valsartan treatment has been shown to reduce the risk of hospitalization and mortality and to improve the quality of life in patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) compared to enalapril. To the best of our knowledge, no data have compared the ischemic and non-ischemic HRrEF groups in Turkey. This study comparatively investigated the effects of sacubitril/valsartan on clinical and laboratory findings in both ischemic and non-ischemic HF groups. Material and Methods: This study included patients with an indication for sacubitril/valsartan treatment initiation according to the HF guidelines. All patients underwent detailed histories, physical examinations, electrocardiograms, and laboratory tests, including sodium (Na), potassium(K), creatinine, and NT-proBNP, both before and 6 months after the treatment. We then compared the pre and post treatment findings. Results: A total of 127 patients (27.6% female), including 71 in the ischemic HF group and 56 in the non-ischemic HF group were enrolled the study. In both groups, systolic and diastolic blood pressures, heart rate per minute, NT-proBNP and sodium levels and weekly furosemide doses decreased significantly after sacubitril/valsartan treatment. While we observed no significant change in the glomerular filtration rate, we saw a statistically significant increase in creatinine and potassium levels. Conclusion: This study's results show the efficacy of sacubitril/valsartan in improving symptoms and cardiac biomarkers while reducing the need for diuretic therapy and heart rate in both ischemic and non-ischemic HFrEF patients. On the other hand, some complications (renal dysfunction, symptomatic hypotension and hyperkalemia) should be considered.

Keywords: Heart failure; LCZ 696; Heart failure, systolic; treatment outcome
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