伊伐布雷定对急性ST抬高型心肌梗死并左室射血分数降低型心力衰竭患者左心室重构指标的影响

Effects of ivabradine on myocardial fibrosis and left ventricular remodeling in patients with ST-segment elevation myocardial infarction and HFrEF type chronic heart failure

目的:探讨伊伐布雷定对急性ST段抬高型心肌梗死(STEMI)并HFrEF型心力衰竭患者及心室重构指标的影响。方法:114例STEMI并HFrEF型心力衰竭患者按照分层区组随机化分为对照组(58例,完成56例)和观察组(58例,完成56例),对照组给予常规抗心力衰竭治疗,观察组在对照组基础上给予伊伐布雷定治疗。2组疗程均为6个月。于治疗前及治疗6个月后,评估2组患者的心功能分级,随访主要终点事件,监测静息心率、平均动脉压,并统计静息心率达标率、平均动脉压正常率及比索洛尔平均日用量,检测心肌纤维化相关指标[转化生长因子-β1(TGF-β1)、结缔组织生长因子(CTGF)、半乳糖凝集素-3(Gal-3)、可溶性ST2(sST2)、Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PⅢ)],左室重构相关指标[左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)、左室心肌质量(LVM)、左室射血分数(LVEF)],记录治疗6个月内药物不良反应。结果:(1)治疗6个月后,观察组患者的疗效优于对照组(Z=-2.136,P=0.033),观察组患者的主要终点事件发生率低于对照组(χ^(2)=4.940,P=0.026);(2)治疗6个月后,观察组患者的静息心率低于对照组(t=4.029,P<0.001),观察组患者的平均动脉压高于对照组(t=-6.615,P<0.001),观察组患者的静息心率达标率及平均动脉压正常率均高于对照组(χ^(2)=48.908,10.980,P<0.01)。治疗6个月内,观察组患者的比索洛尔平均日用量小于对照组(t=27.098,P<0.001);(3)治疗6个月后,观察组患者的心肌纤维化相关指标(TGF-β1、CTGF、Gal-3、sST2、PCⅠ/PCⅢ)及左室重构相关指标(LVESV、LVEDV、LVMI、LVRI、LVEF)的改善优于对照组(均为P<0.05);(4)观察组患者药物不良反应发生率均低于对照组(χ^(2)=3.953,P=0.047)。结论:伊伐布雷定用于STEMI并HFrEF型心力衰竭患者,可更有效地控制静息心率,提高左心室射血分数,减少主要终点事件,减少比索洛尔日用量及药物不良反应,不影响血压,改善心肌纤维化和心室重构的相关指标。

OBJECTIVE To explore the effects of ivabradine on myocardial fibrosis and ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)and HFrEF type chronic heart failure.METHODS Based upon the method of stratified blocked randomization,a total of 112 patients with STEMI with HFrEF heart failure were divided into control group(n=58,56 completing cases)and observation group(n=58,56 completing cases).The control group received conventional antiheart failure treatment while observation group had an additional therapy of ivabradine.Both groups were treated for 6 months.Before and after 6-month treatment,cardiac function ratings were assessed and primary endpoint events followed up.Resting heart rate and mean arterial pressure were monitored and attaining rate of resting heart rate,normal rate of mean arterial pressure and mean daily dose of bisoprol calculated.Myocardial fibrosis related parameters [transforming growth factor-β1(TGF-β1),connective tissue growth factor(CTGF),galectin-3(Gal-3),soluble ST2(sST2),procollagenⅠ(PCⅠ)& procollagen Ⅲ(PⅢ)],parameters of left ventricular remodeling(LVESV,LVEDV,LVM & LVEF)and adverse drug reactions were recorded.RESULTS(1)After 6-month treatment,the efficacy of observation group was better than that of control group(Z=-2.136,P=0.033)and the incidence of primary endpoint events lower in observation group than that in control group(χ^(2)=4.940,P=0.026);(2)After 6-month treatment,resting heart rate of observation group was lower than that of control group(t=4.029,P<0.001).Mean arterial pressure was higher in observation group than that in control group(t=-6.615,P<0.001).Resting heart rate and mean normal arterial pressure were higher in observation group than those in control group(χ^(2)=48.908,10.980,P<0.01).Mean daily dose of bisoprolol was lower in observation group than that in control group during 6-month treatment(t=27.098,P<0.001);(3)After 6-month treatment,the improvement of myocardial fibrosis related parameters(TGF-β1,CTGF,Gal-3,sST2 & PCⅠ/PCⅢ)and left ventricular remodeling related parameters(LVESV,LVEDV,LVMI,LVRI & LVEF)was better in observation group than those in control group(all P<0.05);(4)The incidence of adverse drug reactionswas lower in observation group than that in control group(χ^(2)=3.953,P=0.047).CONCLUSION For patients with STEMI and HFrEF heart failure,ivabradine may control resting heart rate more effectively,boost left ventricular ejection fraction,lower primary endpoint events,reduce bisoprolol daily dosage and adverse drug reactions without affecting blood pressure and improve the related parameters of myocardial fibrosis and ventricular remodeling.