沙库巴曲缬沙坦对心衰合并肺动脉高压患者右室–肺动脉耦联的影响研究

Effects of Sacubitril/Valsartan on the Right Ventricular-Pulmonary Arterial Coupling in Patients with Heart Failure Complicated with Pulmonary Hypertension

摘要: 目的：利用超声心动图观察沙库巴曲缬沙坦对心衰合并肺动脉高压患者的右室–肺动脉耦联的影响。方法：回顾性分析2019年10月至2021年6月于青岛大学附属医院心内科住院治疗的154例心衰合并肺动脉高压患者的临床资料，按治疗方式不同分为对照组(n = 61)和观察组(n = 93)。两组患者均给予常规抗心衰治疗(包括利尿剂、β受体阻滞剂、血管扩张剂的应用)，在此基础上，对照组给予缬沙坦(80 mgQd)，观察组给予沙库巴曲缬沙坦(50 mgBid)，之后根据患者情况逐渐滴定至目标剂量。两组均连续治疗6个月。通过电子病历系统收集入选患者的临床基线资料，用药前、用药6个月时超声心动图的参数指标，包括肺动脉收缩压(Pulmonary artery systolic pressure, PASP)、三尖瓣环收缩期位移(Tricuspid annular plane systolic excursion, TAPSE)、三尖瓣环收缩期位移/肺动脉收缩压比值(T/P比值)、右室长径、右室前后径，及左房前后径、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)的变化情况。结果：对照组(ARB组)与观察组(ARNI组)患者的临床基线资料比较均无统计学差异(P > 0.05)。治疗6个月后，ARNI组的右室–肺动脉耦联指标的改善程度均高于ARB组，包括PASP的下降，TAPSE值及T/P比值的升高，差异均有统计学意义(P < 0.05)；且ARNI组在RV长径、RV前后径、LA前后径的减小方面，及左室重构指标(包括LVESD、LVEDD的减小，LVEF的提高)，较治疗前相比，均存在显著统计学差异(P < 0.05)。结论：沙库巴曲缬沙坦可以有效改善心衰合并肺动脉高压患者的右室–肺动脉耦联，且能降低心衰合并肺动脉高压患者的肺动脉收缩压，并对其右心室功能起到一定改善作用。

Abstract: Objective: Using echocardiography to observe the effects of sacubitril-valsartan on the right ven-tricular arterial coupling in patients with heart failure and pulmonary hypertension. Methods: A total of 154 patients with heart failure and pulmonary hypertension, who were hospitalized in the Department of Cardiovascular Medicine, Affiliated Hospital of Qingdao University from October 2019 to June 2021, were included in this retrospective analysis. According to the different treat-ments, they were divided into the control group (n = 61) and the observation group (n = 93). In ad-dition to conventional treatment, such as diuretics, β-blockers, and vasodilators, the control group was given valsartan by 80 mg daily and the observation group with sacubitril-valsartan by 50 mg twice daily, and gradually titrated to the target recommended or maximum tolerated. Both groups were treated continuously for 6 months. Clinical baseline data and the parameters of echocardiog-raphy before and after treatment were collected through the electronic medical records. The pri-mary effectiveness observation index was pulmonary artery systolic pressure (PASP), tricuspid an-nular plane systolic excursion (TAPSE), TAPSE/PASP (T/P ratio). The secondary observation index was length and anteroposterior diameter of right ventricle. Left atrial anterior-post- erior diameter, Left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) are also recorded and compared. Results: The clinical baseline characteristics were no significant differences between ARNI group and ARB group (P > 0.05). After 6 months of treatment, the improvement degree of right ventricular- pulmonary arteri-al coupling indexes in ARNI group was higher than that in ARB group, including decreased PASP, increased TAPSE value and T/P ratio, the differences were statistically significant (P < 0.05). Com-pared with before treatment, ARNI group had statistically significant differences in the reduction of RV long diameter, RV anterior-posterior diameter, LA anterior-posterior diameter. And left ventric-ular remodeling indexes (including LVESD, LVEDD decreased, and LVEF increased) were also signif-icantly different (P < 0.05). Conclusions: In patients with heart failure complicated with pulmonary hypertension, sacubitril-valsartan can effectively improve the right ventricular- pulmonary arterial coupling and reduce pulmonary artery systolic pressure, with improving right ventricular function to some extent.