超声应变成像评价沙库巴曲缬沙坦治疗HFrEF患者左室重构

陈军红; 李东野; 徐通达; 宣皓晨; 王超凡

doi:10.13201/j.issn.1001-1439.2021.02.007

超声应变成像评价沙库巴曲缬沙坦治疗HFrEF患者左室重构

- 徐州医科大学附属医院心血管内科(江苏徐州, 221006)

详细信息

通讯作者: 李东野,E-mail:Dongyeli@medmail.com.cn

中图分类号: R541.6

收稿日期: 2020-09-07

Evaluation the left ventricular remodeling of patients with chronic heart failure with reduced ejection fraction after treated sacubitril/valsartan using strain imaging echocardiography

- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, China

More Information

Corresponding author: LI Dongye, E-mail: Dongyeli@medmail.com.cn

Received Date: 07 September 2020

摘要

摘要: 目的:评价射血分数减低慢性心力衰竭(HFrEF)患者应用沙库巴曲缬沙坦(LCZ696)治疗6个月后左室重构变化。方法:最终选取左室射血分数(LVEF)≤40%的慢性心力衰竭患者35例。LCZ696应用初始及6个月时采用超声应变成像技术分析左室心肌整体纵向应变(GLS)和圆周应变(GCS)。Simpson双平面法获得左室舒张末容积指数(LVEDVI)、收缩末容积指数(LVESVI)、左心房容积指数(LAVI)以及LVEF。多普勒超声测定舒张早期跨二尖瓣血流速度E峰与二尖瓣环组织速度E′的比值(E/E′)。电化学发光法测定血浆中氨基末端脑钠肽前体(NT-proBNP)浓度。结果:LCZ696治疗6个月后与基线相比,GLS和GCS显著改善,LVEF值较基线水平明显增加,差异有显著统计学意义(P＜0.001);NT-proBNP浓度较基线水平明显降低,其浓度变化与GCS与LVEF变化呈线性弱相关(P＜0.01,P＜0.05)。LVEDVI、LVESVI、LAVI及E/E′较基线水平明显减小(P＜0.001)。结论:HFrEF患者应用LCZ696 6个月后评价左室重构的各项指标明显改善,心肌应变尤其GCS变化对于评价左室重构具有重要意义。LCZ696逆转HFrEF患者心脏重构。
- 沙库巴曲缬沙坦 /
- 慢性心力衰竭 /
- 左室重构
Abstract: Objective: To assess the reverse cardiac remodeling effect of sacubitril/Valsartan(LCZ696) in patients with chronic heart failure with reduced ejection fraction(HFrEF) using strain imaging echocardiography.Methods: The 35 patients with NYHA classⅡ-Ⅳwere enrolled. All patients have reduced left ventricle ejection fraction(LVEF) ≤40% and N-terminal pro-BNP(NT-proBNP) ≥400 pg/ml. All the patients underwent examinations with 2 D echocardiography at baseline and 6 month after taking(LCZ696). The changes of global longitudinal and circumferential strain(GLS and GCS) were assessed by strain imaging technology. The changes of LV end-diastolic volume index(LVEDVI), LV end-systolic volume index(LVESVI), LVEF and left atrial volume index(LAVI) were accquired by Simpson method. Doppler examination was used to get the ratio of early transmitral Doppler velocity/early diastolic annular velocity(E/E′). The changes of serum NT-proBNP concentration were determined by electrochemiluminescence immunoassay(ECLIA) method.Results: Significant improvement was identified for GLS from(-9.46±1.14)% to(-14.50±1.22)% and for GCS from(-11.86±1.27)% to(-20.38±2.40)% at 6 th month after taking LCZ696(P＜0.001). LVEF was improved over the duration of the study from(27.43±3.09)% to(34.90±2.43)%(P＜0.001) at 6 th month. The median NT-proBNP concentration decreased significantly from(1884±403.9) pg/ml at baseline to(983±244.2) pg/ml at 6 th month(P＜0.001). Reduction in NT-proBNP concentration was weakly correlated with the change of GCS and LVEF(P＜0.01 and P＜0.05). LVEDVI decreased significantly from(91.13±2.97) ml/m²to(78.05±1.78) ml/m², and LVESVI decreased from(66.05±3.56) ml/m²to(51.03±2.65) ml/m²(P＜0.001). LAVI and E/E′also decreased significantly(P＜0.001).Conclusion: LCZ696 exhibited a significant improvement in LV remodeling. It is reliable and feasible to use strain imaging to evaluate the LV remodeling in HFrEF patients, especially the GCS can predict the functional remodeling in patients with HFrEF.
- sacubitril/valsartan /
- chronic heart failure /
- left ventricular remodeling

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