沙库巴曲缬沙坦对射血分数降低心衰患者心脏结构及心功能的影响

Effects of Sacubitril/Valsartan on Cardiac Structure and Cardiac Function of Patients with Heart Failure and Reduced Ejection Fraction

摘要: 目的：观察沙库巴曲缬沙坦(Sacubitril-Valsartan, SV)对射血分数降低的心力衰竭(heart failure with reduced ejection fraction, HFrEF)患者心脏结构及心功能的影响。方法：选取105例HFrEF患者进行回顾性研究。收集基线和SV治疗6个月后临床参数以及左心室射血分数(left ventricular ejection fraction, LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter, LVD)、左心房内径(left atrial diameter, LAD)、室间隔厚度(ventricular septal thickness, IVST)、左心室后壁厚度(left ventricular posterior wall thickness, LVPWT)、E/A、E/e’、左心室重量指数(left ventricular mass index, LVMI)等超声心动图指标。结果：随访6个月时，NYHA等级、B型氨基端利钠肽原(N-terminal pro-B-type natriuretic peptide, NT-proBNP)水平较基线明显降低；整体LVEF明显改善，LVD、IVST、LVMI明显降低。同时LAD、E/e’也有所改善。长病程组(心衰病史至少1年)患者中仅LVEF和LVD有所改善，短病程组(心衰病史 < 1年)患者中，大多数超声心动图参数在SV治疗后有所改善。女性亚组与长病程组结果基本一致，而男性亚组结果近似短病程组。P均 < 0.05，差异有统计学意义。结论：研究显示ARNI具有明显的逆转心脏重构特性，并能在一定程度上改善心功能。在亚组分析中，男性和短病程组的患者表现出的逆转重构程度更明显。

Abstract: Objective: To observe effects of Sacubitril-Valsartan (SV) on cardiac structure and function in patients with heart failure and reduced ejection fraction (HFrEF). Methods: A retrospective study was conducted on 105 patients with HFrEF. The clinical parameters and echocardiographic parameters such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVD), left atrial diameter (LAD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), E/A, E/e' and left ventricular mass index (LVMI) were collected at baseline and 6 months after SV treatment. Results: During the 6-month follow-up, the NYHA grade and the level of B-type N-terminal natriuretic peptide (NT-proBNP) were significantly lower than the baseline, the overall LVEF was significantly improved, and LVD, IVST and LVMI were significantly decreased. At the same time, LAD and E/e’ were also improved. Patients with heart failure duration of at least 1 year showed improvements in LVEF and LVD, while in the subgroup with mean disease duration less than 1 year, most of the echocardiographic parameters were improved after SV treatment. The result of female subgroup was basically the same as that of long course group, while that of male subgroup was similar to that of short course group. P < 0.05, the difference was statistically significant. Conclusion: Study has shown that Sacubitril-Valsartan can significantly reverse cardiac remodeling and improve cardiac function to some extent. In the subgroup analysis, the degree of reverse remodeling was more obvious in men and patients with short course of disease.