Sakubitril/valsartanın klinik olarak miyokardit şüphesi olan hastalarda etkisi

Abstract

Giriş-Amaç: Akut miyokardit, klinik olarak sessiz, hafif,kendi kendini sınırlayan durumlardan, kadriyojenik şok ve ölümcül sonuçlar gibi ciddi yaşamı tehdit eden durumlara kadar uzanan heterojen yapısıyla tedavide zorluk yaratan bir klinik durumdur. Sakubitril/ valsartan hem renin-anjiyotensin-aldosteron sistemini (valsartan tarafından bloke edilir) hem de natrüjenik peptid sistemini (sakubitril tarafından neprilisin inhibisyonu) etkiler. Ejeksiyon fraksiyonu düşüklüğü olan kalp yetmezliğinin tedavisinde temel tedavilerden biridir. Klinik olarak şüpheli subakut miyokardit ve hafif ejeksiyon fraksiyonu düşüklüğü olan hastalarda sakubitril/valsartan tedavisini değerlendirdik. Yöntemler: Hafif ejeksiyon fraksiyonu düşüklüğü olan klinik olarak şüpheli subakut miyokardit tanısı alan 7 hastayı deüerlendirdik. Tüm hastalara kabul sırasında sakubitril/valsartan başlandı. Hastaları başvuru anındaki ve takip eden dönemdeki (6.ayda) ekokardiyografik bulgular açısından analiz ettik. Bulgular: Çalışma grubunda 5 erkek (%71) ve 2 kadın (%29) vardı. Yatış sırasında tüm hastalar sakubitril/valsartan aldı. NYHA fonksiyonu ve BNP düzeyleri şu anda (Sınıf-3, 704.75±143) 6 aylık takipten sonra azaldı. (Sınıf-2, 65.17±14.58) Diyastolik çap, sol atriyum çapı ve E/E' kabul sırasında (56.04±3.07, 41.77±1.23 ve 14.83±0.25) 6 aylık takipten sonra (48,04±2,07, 37,57±1,23 ve 7,7±0,14) azaldı. Ejeksiyon fraksiyonu kabul sırasında (42,13±2,63) 6 aylık takip sonrasında (51,13±2,63) artış gösterdi. Sonuç: Klinik olarak şüpheli subakut miyokardit tedavisinde sakubitril/valsartan tedavisi etkili bir alternatif olabilir.

Keywords

• miyokardit
• sakubitril/valsartan
• kalp yetmezliği

Effect of sacubitril/valsartan in patients with clinically suspected myocarditis

Abstract

Aims: Acute myocarditis is a clinical condition that poses a challenge in clinical management, with its heterogeneous character ranging from clinically silent, mildly self-limiting conditions to serious, life threatening conditions including cardiogenic shock and fatal outcomes. Sacubitril/valsartan affects both the renin-angiotensin-aldosterone system (blockage by valsartan) and the natriuretic peptide system (neprilysin inhibition by sacubitril) pathways. It is one of the main therapies in the management of heart failure with reduced ejection fraction. We evaluated patients who received sacubitril/valsartan therapy with subacute clinically suspected myocarditis and mild reduced ejection fraction. Methods: We evaluated 7 patients who diagnosed subacute clinically suspected myocarditis with mild reduced ejection fraction. On admission, all patients took sacubitril/valsartan. We analyzed those patients in terms of the echocardiographic findings at presentation and following time (at 6 months). Results: The study group included 5 male (71%) and 2 female (29%). During admission, all patients took sacubitril/valsartan. NYHA function and BNP levels at present (class-3, 704.75±143) decrease after 6-monthfollow-up. (class-2, 65.17±14.58). Left ventricle diastolic diameter, left atrium diameter, and E/ E’ at present (56.04±3.07, 41.77±1.23 and 14.83±0.25) decrease after 6-month follow-up. (48.04±2.07, 37.57±1.23 and 7.7±0.14). Ejection fraction increased after 6-month follow-up (from 42.13±2.63) to 51.13±2.63). Conclusion: In subacute clinically suspected myocarditis, sacubitril/valsartan therapy could be an effective alternative.

Keywords

• Heart failure
• myocarditis
• sacubitril/valsartan

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