实用医学杂志2025，Vol.41Issue(9)：1379-1386,8.DOI:10.3969/j.issn.1006-5725.2025.09.016
真实世界中维立西呱联合"四联疗法"对射血分数降低型心力衰竭的疗效
Clinical efficacy of vericiguat in combination with"Quadruple Therapy"for patients with heart failure and reduced ejection fraction in real-world settings
摘要
Abstract
Objective To evaluate the clinical efficacy and safety of vericiguat combined with the new"Quadruple Therapy"for treating heart failure with reduced ejection fraction(HFrEF)and to explore its impact on left ventricular reverse remodeling(LVRR)in patients with different baseline characteristics.Methods A total of 87 patients with chronic heart failure treated with vericiguat at the Department of Cardiology,Nanjing Drum Tower Hospital from June 2022 to March 2024,were consecutively enrolled as the observation group.These patients were matched at 1:1 by age,sex,and left ventricular ejection fraction(LVEF)with 87 patients who received the standard quadruple therapy without vericiguat as the control group.Propensity score matching was used to further balance confounding factors,resulting in 64 patients in each group for final analysis.Changes in echocardiographic parameters,liver and kidney function,electrolyte levels,and blood pressure were analyzed at baseline and during the 6-month follow-up to assess the efficacy and safety of vericiguat.The primary efficacy endpoint was the occurrence of LVRR.Subgroup analyses were conducted based on baseline characteristics such as age and sex.Interaction analysis was utilized to evaluate the heterogeneity of vericiguat's efficacy.Results After 6 months of treatment,the vericiguat group showed significant improvements in cardiac structure and function compared to the control group.The left ventricular end-diastolic diameter was significantly reduced[-0.43(-1.00,-0.10)mm vs.-0.22(-0.53,0.02)mm,P=0.002],and the LVEF was significantly increased[8.45％(1.40％,16.50％)vs.2.75％(0,11.00％),P=0.002].The percentage of patients in the vericiguat group who achieved LVRR was significantly larger than in the control group(46.4％vs.27.4％,P=0.011).Multivariate logistic regression revealed that the combination of vericiguat was an independent predictor of LVRR(Model 2:OR=2.54,95％CI:1.29～5.01,P=0.007).The reverse remodeling effect remained consistent across different subgroups and was not significantly influenced by specific baseline characteristics(Pinteraction>0.05).Vericiguat did not affect blood pressure,liver and kidney function,or electrolyte levels,achieving satisfactory safety,despite its significantly higher incidence of gastrointestinal reactions(16.1％vs.5.7％,P<0.001).Conclusion The addition of vericiguat to the quadruple therapy significantly improves cardiac function and promotes left ventricular reverse remodeling in HFrEF patients while maintaining a favorable safety profile.关键词
维立西呱/心力衰竭/四联疗法/左心室重构/队列研究Key words
vericiguat/heart failure/quadruple therapy/left ventricle reverse remodeling/cohort study分类
医药卫生引用本文复制引用
陈琳,邬保川,吴少军,王奕,付毅蓓,刘晓丽,顾蓉..真实世界中维立西呱联合"四联疗法"对射血分数降低型心力衰竭的疗效[J].实用医学杂志,2025,41(9):1379-1386,8.基金项目
国家自然科学基金资助项目(编号:82300384) （编号:82300384）
南京鼓楼医院青年培育基金资助项目(编号:2013-LCYJ-PY-34) （编号:2013-LCYJ-PY-34）
