斑点追踪超声技术评价HFmrEF患者短期应用沙库巴曲缬沙坦治疗前后左心结构和功能的变化

Using speckling tracking echocardiography to evaluate left cardiac structure and function of heart failure patients with mid-range ejection fraction following short-term treatment of sacubitril/valsartan

目的:利用先进的斑点追踪超声技术评价射血分数中间值心衰(heart failure with mid-range ejection fraction,HFmrEF)患者应用沙库巴曲缬沙坦治疗3个月后左心结构和功能变化。方法:选取2020年7月—2021年1月徐州医科大学附属医院就诊的射血分数在40%~49%之间的纽约心功能分级(NYHA)Ⅱ~Ⅲ级心衰患者共35例。二维斑点追踪超声评价初始及使用沙库巴曲缬沙坦治疗3个月后左室整体纵向应变(left ventricular global longitudinal strain,LVGLS)、左室各节段纵向应变达峰时间。Simpson双平面法测量左室舒张末容积指数(left ventricular end-diastolic volume index,LVEDVI)、左室收缩末容积指数(left ventricular end-systolic volume index,LVESVI)、左心房容积指数(left atrial volume index,LAVI)及左室射血分数(left ventricular ejection fraction,LVEF)。彩色血流多普勒及组织多普勒测定舒张早期跨二尖瓣血流速度E峰与二尖瓣环速度e’的比值(E/e’)。化学发光法测定血浆氨基末端脑钠肽前体(amino-terminal pro-brain natriuretic peptide,NT-proBNP)浓度。结果:沙库巴曲缬沙坦治疗3个月与基线相比:患者NYHA分级明显改善(P=0.008),NT-proBNP浓度明显降低(P <0.001)。LVGLS较基线明显改善,左室各节段纵向应变达峰时间较基线明显缩短(P <0.001)。常规超声指标LVEF较治疗前有所改善(P=0.001),LVEDVI及LVESVI较基线水平明显缩小(P <0.001),LAVI及E/e’比值差异无明显统计学意义(P> 0.05)。结论:HFmrEF患者应用沙库巴曲缬沙坦3个月即可实现左心结构和功能的明显改善,斑点追踪超声基础上的应变及应变率分析是评价此类心衰患者左室重构的重要指标。

Objective:This study aims to assess the cardiac structure and function in patients of heart failure with mid-range ejection fraction(HFmrEF)by speckling tracking echocardiography after 3 months sacubitril/valsartan treatment. Methods:A total of35 patients with HFmrEF(EF range:40%~49%)and New York Heart Association(NYHA)class Ⅱ~Ⅲ were enrolled in this study from Jul 2020 to Jan 2021. In these patients,echocardiographic assessments were performed at the baseline and after 3 months sacubitril/valsartan therapy. The left ventricular(LV) global longitudinal strain(LVGLS) and the time to the peak strain were evaluated by using speckling tracking,the LV end-diastolic volume index(LVEDVI),LV end-systolic volume index(LVESVI),LV ejection fraction(LVEF)and left atrial volume index(LAVI)were acquired by Simpson’s method. Color and tissue Doppler ultrasound were utilized to get the ratio of early transmitral Doppler velocity/early diastolic annular velocity(E/e’). The level of serum aminoterminal pro-brain natriuretic peptide(NT-proBNP)was determined by electrochemiluminescence immunoassay method. Results:After the treatment,the NYHA function capacity class improved significantly(P=0.008),and the median NT-proBNP concentration decreased significantly(P < 0.001). The LVGLS increased markedly compared with the baseline,and the time to peak longitudinal strain reduced significantly than the baseline(P < 0.001). There was a modest improvement in the LVEF(P=0.001). The LVEDVI and LVESVI decreased significantly compared with the baseline(P < 0.001). However,there was no significant change for LAVI and the E/e’(both P > 0.05). Conclusion:In HFmrEF patients,3 months sacubitril/valsartan therapy could induce benefit on the left cardiac structure and function. Strain analysis based on speckling tracking echocardiography may act as a useful tool for assessment of the left ventricle remodeling in these patients.