沙库巴曲缬沙坦对慢性心力衰竭患者室性心律失常及心率变异性的影响

Effects of sacubitril/valsartan on ventricular arrhythmia and heart rate variability in patients with chronic heart failure

目的 探讨沙库巴曲缬沙坦对慢性心力衰竭(心衰)患者室性心律失常、心率变异性和心功能的影响。方法 90例慢性心衰伴室性心律失常患者随机均分为两组,在常规抗心衰治疗的基础上,试验组加用沙库巴曲缬沙坦口服,对照组加用贝那普利或厄贝沙坦口服,疗程12周。比较两组治疗前后24-h动态心电图室性心律失常指标(室性早搏次数、室性心动过速阵数)、心率变异性指标[全部窦性心搏R-R间期标准差(SDNN)、全程每5分钟时间段R-R间期平均值的标准差(SDANN)、相邻R-R间期差的均方根(RMSSD)和相邻R-R间期差≥50 ms的百分数(pNN50)]、心脏彩色多普勒超声左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)和6-min步行试验距离(6MWD)。结果 与治疗前相比,两组治疗后24-h动态心电图室性早搏次数、室性心动过速阵数以及LVEDd减少(P<0.05),SDNN、SDANN、RMSSD、pNN50、LVEF和6MWD增加(P<0.05),且试验组均优于对照组(P<0.05)。结论 与血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂相比,沙库巴曲缬沙坦能更好地改善慢性心衰患者室性心律失常、心率变异性和心功能。

Objective To explore the effects of sacubitril/valsartan on ventricular arrhythmia, heart rate variability and cardiac function in the patients with chronic heart failure.Methods Ninety patients with chronic heart failure and ventricular arrhythmia were randomly and equally divided into two groups.On the basis of routine anti-heart failure treatment, group A was given oral administration of sacubitril/valsartan, and group C was given oral administration of benazepril or irbesartan for 12 weeks.The Holter ventricular arrhythmia indexes(numbers of ventricular premature contractions and ventricular tachycardia array),heart rate variability indexes [standard deviation of R-R intervals(SDNN),standard deviation of the average of all R-R intervals in every 5-minute intervals(SDANN),root mean square of successive R-R intervals differences(RMSSD),percentage of adjacent R-R intervals varying by more than 50 ms(pNN50)],left ventricular end-diastolic diameter(LVEDd) and left ventricular ejection fraction(LVEF) by color Doppler echocardiography, and 6-minute walking distance(6 MWD) were compared between the two groups before and after treatment.ResultsCompared with before treatment, the numbers of ventricular premature contractions and ventricular tachycardia array and LVEDd were decreased(P<0.05),while SDNN,SDANN,RMSSD,pNN50,LVEF and 6 MWD were increased in the two groups after treatment(P<0.05),which were changed more obviously in group A than those in group C(P<0.05).Conclusion Compared with angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists, sacubitril/valsartan can better improve ventricular arrhythmia, heart rate variability and cardiac function in the patients with chronic heart failure.