沙库巴曲缬沙坦对心功能Ⅳ级患者左房重构的影响

朱章进; 黎敬锋; 王超; 李银; 牛杰; 徐晓飞; 胡昊

doi:10.16766/j.cnki.issn.1674-4152.002940

沙库巴曲缬沙坦对心功能Ⅳ级患者左房重构的影响

doi: 10.16766/j.cnki.issn.1674-4152.002940

朱章进¹,
黎敬锋^1, ,,
王超¹,
李银¹,
牛杰¹,
徐晓飞¹,
胡昊²

1.
滁州市第一人民医院心血管内科，安徽滁州 239000
2.
安徽省立医院心血管内科，安徽合肥 230001

基金项目:

安徽省卫生健康委科研项目 AHWJ2021b080

详细信息

通讯作者:
黎敬锋，E-mail: lijingfeng6016@126.com

中图分类号: R541.6 R972.4
计量
- 文章访问数: 297
- HTML全文浏览量: 149
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-04
- 网络出版日期: 2023-05-31

Effect of sacubitril/valsartan on left atrial remodeling in patients with class Ⅳ cardiac function

1.
Department of Cardiology, the First People's Hospital of Chuzhou, Chuzhou, Anhui 239000, China

摘要

摘要: 目的观察沙库巴曲缬沙坦对心功能Ⅳ级患者左房超声指标的变化，并探讨其对左房重构的影响。方法回顾性分析2020年1月—2021年4月于滁州市第一人民医院住院治疗的NYHA Ⅳ级的射血分数降低心力衰竭（HFrEF）患者90例，按药物治疗分为血管紧张素脑啡肽酶抑制剂沙库巴曲缬沙坦(ARNI)组(48例)和血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)组(42例), 比较2组治疗1年后左房重构超声指标变化以及变化幅度。结果随访时，ARNI组左房横径(LATD)较ACEI/ARB组缩短更明显[（-6.92±4.09）mm vs.（-3.60±4.48）mm，P < 0.001]；ARNI组左房容积(LAV)较ACEI/ARB组缩小更明显[（-11.76±5.73）mL vs.（-8.14±6.21）mL，P=0.005]；ARNI组左房容积指数(LAVI)较ACEI/ARB组减小更明显[（-6.38±4.55）mL/m² vs.（-4.16±3.69）mL/m²，P=0.014)]；ARNI组左房球形指数(LASI)较ACEI/ARB组减小更明显（-0.09±0.14 vs. 0.01±0.11，P=0.003）。此外，ARNI组达到左房逆重构(LARR)患者数更高[26（54.2%）vs. 14(33.3%)，P=0.047]。结论在NYHA Ⅳ级的HFrEF患者中，与ACEI/ARB组相比，应用沙库巴曲缬沙坦治疗可更好地减低患者的LATD、LAV、LAVI、LASI，提高LARR率。
- 心力衰竭 /
- 沙库巴曲缬沙坦 /
- 左房重构
Abstract: Objective To investigate the effects of sacubitril/valsartan on the left atrial parameters and remodeling in echocardiography among patients with New York Heart Association(NYHA) class Ⅳ heart failure. Methods A total of 90 heart failure and a reduced ejection fraction (HFrEF) patients with NYHA class Ⅳ hospitalized in the First People's Hospital of Chuzhou were retrospectively analyzed. According to drug treatment, they were divided into two groups: the angiotensin enkephalin inhibitor (ARNI) group (48 cases) and the angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor antagonist (ACEI/ARB) group (42 cases), and the changes and amplitude of left atrial remodeling ultrasound indexes in the two groups after 1 year of treatment were compared. Results During follow up, the left atrial transverse diameter (LATD) in ARNI group was significantly shorter than that in ACEI/ARB group [(-6.92±4.09) mm vs. (-3.60±4.48) mm, P < 0.001]; the left atrial volume (LAV) of ARNI group was significantly smaller than that of ACEI/ARB group [(-11.76±5.73) mL vs. (-8.14±6.21) mL, P=0.005]; the left atrial volume index (LAVI) in ARNI group decreased more significantly than that in ACEI/ARB group [(-6.38±4.55) mL/m² vs. (-4.16±3.69) mL/m², P=0.014)]; the left atrial globular index (LASI) in ARNI group decreased more significantly than that in ACEI/ARB group (-0.09±0.14 vs. 0.01±0.11, P=0.003). In addition, the number of patients with left atrial reverse remodeling (LARR) in ARNI group was higher [26 (54.2%) vs. 14 (33.3%), P=0.047]. Conclusion Compared with ACEI/ARB group, the treatment of sacubitril/valsartan can better reduce the LATD, LAV, LAVI, LASI, and improve LARR in HFrEF patients with NYHA class Ⅳ.
- Heart failure /
- Sacubitril/valsartan /
- Left atrial remodeling

HTML全文

表 1 2组心力衰竭患者基线资料比较

Table 1. Comparison of baseline data between two groups of heart failure patients

项目	ARNI组(n=48例)	ACEI/ARB组(n=42例)	统计量	P值
性别[例(%)]			0.589^a	0.443
男性	29(60.4)	22(52.3)
女性	19(39.6)	20(47.7)
年龄(x±s，岁)	69.3±7.4	68.2±7.9	0.627^b	0.532
BSA(x±s，m²)	1.73±0.14	1.72±0.09	0.450^b	0.654
收缩压[M(P₂₅, P₇₅)，mmHg]	114(105，144)	118(110，125)	-1.218^c	0.223
舒张压[M(P₂₅, P₇₅)，mmHg]	73(66，79)	76(67，83)	-0.854^c	0.393
心衰病程(x±s，月)	67.5±18.5	62.6±22.9	1.130^b	0.261
心率(x±s，次/min)	83.21±9.63	82.31±9.14	0.452^b	0.652
冠心病[例(%)]	28(58.3)	27(64.3)	0.334^a	0.563
高血压[例(%)]	23(47.9)	24(57.1)	0.764^a	0.382
慢性阻塞性肺病[例(%)]	11(22.9)	8(19.0)	0.201^a	0.654
房颤/房扑[例(%)]	12(25.0)	9(21.4)	0.160^a	0.689
实验室指标
血钾(x±s，mmol/L)	3.88±0.31	3.79±0.30	1.437^b	0.154
肌酐[M(P₂₅, P₇₅)，μmol/L]	94(79, 104)	93(76, 106)	-0.146^c	0.884
BNP[M(P₂₅, P₇₅)，pg/mL]	1 450(907, 2 290)	1 235(995, 1 520)	-1.023^c	0.306
心超指标
LVEDD(x±s，mm)	60.04±3.94	60.55±2.37	-0.726^b	0.470
LVEF(x±s，%)	32.46±3.39	31.98±3.24	0.687^b	0.494
LAD(x±s，mm)	43.83±2.83	43.29±3.70	0.793^b	0.430
LATD(x±s，mm)	60.65±4.90	60.74±3.66	-0.092^b	0.927
LASID(x±s，mm)	45.46±2.91	46.45±2.67	-1.680^b	0.097
LAV(x±s，mL)	63.77±10.98	64.20±9.17	-0.201^b	0.841
LAVI(x±s，mL/m²)	37.11±7.09	37.48±5.98	-0.264^b	0.792
LASI(x±s)	1.34±0.11	1.31±0.09	1.283^b	0.203
药物使用[例(%)]
β受体阻滞剂	46(95.8)	40(95.2)	0.019^a	0.891
利尿剂	45(93.8)	41(97.6)	0.790^a	0.374
醛固酮受体拮抗剂	44(91.7)	38(90.5)	0.039^a	0.843
地高辛	8(16.7)	6(14.3)	0.097^a	0.756
注：^a为χ²值，^b为t值，^c为Z值。1 mmHg=0.133 kPa。

下载: 导出CSV

表 2 2组心力衰竭患者随访血压、心率及实验室检查比较

Table 2. Comparison of follow-up blood pressure, heart rate and laboratory examination between the two groups of heart failure patients

组别	例数	收缩压[M(P₂₅, P₇₅)，mmHg]		舒张压[M(P₂₅, P₇₅)，mmHg]		心率(x±s，次/min)
组别	例数	基线	随访	基线	随访	基线	随访
ARNI组	48	114(105, 144)	102(98, 107)^b	73(66, 79)	65(60, 68)^b	83.21±9.63	75.81±7.38^b
ACEI/ARB组	42	118(110, 125)	109(102, 112)^b	76(67, 83)	68(63, 72)^b	82.31±9.14	79.02±5.49^b
统计量		-1.218^a	-3.234^a	-0.854^a	-2.250^a	0.452^c	-2.315^c
P值		0.223	0.001	0.393	0.024	0.652	0.023

组别	例数	血钾(x±s，mmol/L)		肌酐[M(P₂₅, P₇₅)，μmol/L]		BNP[M(P₂₅, P₇₅)，pg/mL]
组别	例数	基线	随访	基线	随访	基线	随访
ARNI组	48	3.88±0.31	4.32±0.58^b	94(79, 104)	106(85, 135)^b	1 450(907, 2 290)	800(678, 908)^b
ACEI/ARB组	42	3.79±0.30	4.01±0.53^b	93(76, 106)	98(90, 116)^b	1 235(995, 1 520)	945(858, 1 050)^b
统计量		1.437^c	2.682^c	-0.146^a	-1.504^a	-1.023^a	-3.378^a
P值		0.154	0.009	0.884	0.132	0.306	0.001
注：^a为Z值，^c为t值；与同组基线比较，^bP＜0.05。

下载: 导出CSV

表 3 2组心力衰竭患者随访心超指标及变化值的比较

Table 3. Comparison of follow-up cardiac ultrasound indicators and changes between the two groups of heart failure patients

组别	例数	LVEDD(x±s，mm)		LVEF(x±s，%)		LAD(x±s，mm)		LATD(x±s，mm)
组别	例数	随访	变化值	随访	变化值	随访	变化值	随访		变化值
ARNI组	48	57.81±3.44	-2.23±1.55	39.21±4.24	6.75±3.89	42.26±3.82	-1.57±2.51	53.73±4.59		-6.92±4.09
ACEI/ARB组	42	58.64±2.54	-1.90±1.75	36.57±3.34	4.60±4.01	42.31±3.06	-0.98±1.80	57.14±4.67		-3.60±4.48
统计量		-1.287^a	-0.933^a	3.242^a	2.584^a	-0.069^a	-1.281^a	-3.485^a		-3.683^a
P值		0.202	0.353	0.002	0.011	0.945	0.203	0.001		＜0.001

组别	例数	LASID(x±s，mm)		LAV(x±s，mL)		LAVI(x±s，mL/m²)		LASI(x±s)		LARR随访[例(%)]
组别	例数	随访	变化值	随访	变化值	随访	变化值	随访	变化值	LARR随访[例(%)]
ARNI组	48	43.56±3.91	-1.90±3.99	52.01±9.21	-11.76±5.73	30.73±5.88	-6.38±4.55	1.24±0.15	-0.09±0.14	26(54.2)
ACEI/ARB组	42	44.01±2.89	-2.45±2.41	56.06±9.37	-8.14±6.21	33.32±5.69	-4.16±3.69	1.30±0.10	0.01±0.11	14(33.3)
统计量		-0.604^a	0.779^a	-2.065^a	-2.874^a	-2.113a	-2.514a	-2.092^a	-3.018^a	3.937^b
P值		0.547	0.438	0.042	0.005	0.037	0.014	0.039	0.003	0.047
注：变化值为2组随访与基线比较的差值；^a为t值，^b为χ²值。

下载: 导出CSV

参考文献(16)

[1]	DOCHERTY K F, VADUGANATHAN M, SOLOMON S D, et al. Sacubitril/Valsartan: neprilysin inhibition 5 years after PARADIGM-HF[J]. JACC Heart Fail, 2020, 8(10): 800-810. doi: 10.1016/j.jchf.2020.06.020
[2]	SUN Y, SONG S, ZHANG Y, et al. Effect of angiotensin receptor neprilysin inhibitors on left atrial remodeling and prognosis in heart failure[J]. ESC Heart Fail, 2022, 9(1): 667-675. doi: 10.1002/ehf2.13691
[3]	MANN D L, GIVERTZ M M, VADER J M, et al. Effect of treatment with Sacubitril /Valsartan in patients with advanced heart failure and reduced ejection fraction: a randomized clinical trial[J]. JAMA Cardiol, 2022, 7(1): 17-25. doi: 10.1001/jamacardio.2021.4567
[4]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南(2018)[J]. 中华心血管病杂志, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004 Heart Failure Group, Chinese Society of Cardiology, Chinese Medical Doctor Association, Heart Failure Committee, Editorial Committee of Chinese Journal of Cardiology. Chinese guideline for diagnosis and treatment of heart failure 2018[J]. Chinese Journal of Cardiology, 2018, 46(10): 760-789. doi: 10.3760/cma.j.issn.0253-3758.2018.10.004
[5]	CASTRICHINI M, MANCA P, NUZZI V, et al. Sacubitril/Valsartan induces global cardiac reverse remodeling in long-lasting heart failure with reduced ejection fraction: standard and advanced echocardiographic evidences[J]. J Clin Med, 2020, 9(4): 906. doi: 10.3390/jcm9040906
[6]	黎冉, 谢丽娟, 焦长青, 等. 沙库巴曲缬沙坦对不同射血分数心力衰竭患者的疗效及预后[J]. 中华全科医学, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716 LI R, XIE L J, JIAO C Q, et al. Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with dif-ferent ejection fraction[J]. Chinese Journal of General Practice, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716
[7]	MELO M, CAIFFA T, GOBBO M, et al. Reverse remodeling in dilated cardiomyo-pathy: insights and future perspectives[J]. Int J Cardiol Heart Vasc, 2018, 18: 52-57. http://www.sciencedirect.com/science/article/pii/S2352906718300071/pdfft?md5=733e22ca27aec5e42b479764ac28bad3&pid=1-s2.0-S2352906718300071-main.pdf
[8]	THOMAS L, MARWICK T H, POPESCU B A, et al. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review[J]. J Am Coll Cardiol, 2019, 73(15): 1961-1977. doi: 10.1016/j.jacc.2019.01.059
[9]	OKUTUCU S, FATIHOGLU S G, SABANOGLU C, et al. Effect of angiotensin rece-ptor neprilysin inhibition on P-wave dispersion in heart failure with reduced ejection fraction[J]. Herz, 2021, 46(Suppl1): 69-74.
[10]	BOUWMEESTER S, MAST T P, KEULARDS D C J, et al. Left atrial reverse remodeling predicts long-term survival after cardiac resynchronization therapy[J]. J Echocardiogr, 2022, 20(2): 115-123. doi: 10.1007/s12574-021-00559-0
[11]	GÜZEL T, KIŞ M, ŞENÖZ O. The correlation between the left atrial volume index and atrial fibrillation development in heart failure with mildly reduced ejection fraction and long-term follow-up results[J]. Acta Cardiol, 2022, 4(24): 1-8.
[12]	RI T, SAITO C, ARASHI H, et al. Increased left atrial volume index is associated with more cardiovascular events in patients with acute coronary syndrome: HIJ-PROPER study findings[J]. Echocardiography, 2022, 39(2): 260-267. doi: 10.1111/echo.15301
[13]	KHAN M S, FELKER G M, PIÑA I L, et al. Reverse cardiac remodeling following initiation of Sacubitril/Valsartan in patients with heart failure with and without diabetes[J]. JACC Heart Fail, 2021, 9(2): 137-145. doi: 10.1016/j.jchf.2020.09.014
[14]	YAZAKI M, NABETA T, INOMATA T, et al. Clinical significance of left atrial geometry in dilated cardiomyopathy patients: a cardiovascular magnetic resonance study[J]. Clin Cardiol, 2021, 44(2): 222-229. doi: 10.1002/clc.23529
[15]	NAKAMORI S, NGO L H, TUGAL D, et al. Incremental value of left atrial geometric remodeling in predicting late atrial fibrillation rcurr- ence after pulmonary vein isolation: a cardiovascular magnetic reson- ance study[J]. J Am Heart As-soc, 2018, 19: 1-13. http://www.ncbi.nlm.nih.gov/pubmed/30371333
[16]	LI L Y, LOU Q, LIU G Z, et al. Sacubitril/Valsartan attenuates atrial electrical and structural remodelling in a rabbit model of atrial fibrillation[J]. Eur J Pharmacol, 2020, 881: 173120. DOI: 10.1016/j.ejphar.2020.173120.