沙库巴曲缬沙坦对HFrEF和HFpEF患者的临床效果研究

Clinical effect of sacubitril/valsartan on patients with HFrEF and HFpEF

目的 探究沙库巴曲缬沙坦对射血分数降低的心力衰竭(HFrEF)和射血分数保留的心力衰竭(HFpEF)患者临床疗效及右心结构功能影响,并比较应用沙库巴曲缬沙坦后两组患者症状性低血压的发生情况。方法 回顾性选取2020年8月至2022年3月秦皇岛市第一医院心血管内科收治的120例慢性心力衰竭患者,根据左心室射血分数(LVEF)分成HFrEF组(n=60)和HFpEF组(n=60)。两组均接受常规的抗心力衰竭治疗,在此基础上接受沙库巴曲缬沙坦治疗。比较两组治疗3个月后的临床疗效、6 min步行试验距离(6MWD)、明尼苏达心衰生活质量(MLHFQ)评分及右心结构功能指标[三尖瓣环平面收缩期位移(TAPSE)、三尖瓣环侧壁收缩期速度峰值(s’)、右心室面积变化分数(RVFAC)、右心房内径(RAD)、右室基底部横径(RVD)],并比较应用沙库巴曲缬沙坦后症状性低血压的发生情况。结果 治疗前,两组患者6MWD、MLHFQ评分、RAD比较,差异均无统计学意义(P>0.05),HFrEF组TAPSE、S’、RVFAC均低于HFpEF组,RVD高于HFpEF组,差异均有统计学意义(P<0.05)。治疗3个月后,HFrEF组TAPSE、S’、RVFAC较治疗前增加,RVD较治疗前降低,HFpEF组TAPSE较治疗前增加,差异均有统计学意义(P<0.05)。治疗3个月后,HFrEF组总有效率、6MWD为[95.00%、(421.6±44.1) m],明显高于HFpEF组[83.33%、(403.2±42.5) m];HFrEF组MLHFQ评分为(31.6±7.9)分,低于HFpEF组[(39.5±8.8)分],差异均有统计学意义(P<0.05)。HFrEF组症状性低血压的发生率为23.3%,高于HFpEF组(8.3%),差异有统计学意义(P<0.05)。结论 沙库巴曲缬沙坦对HFrEF和HFpEF患者治疗均有疗效,且均能改善右心功能。但HFrEF患者更易发生症状性低血压,治疗时需严密监测血压。

Objective To explore the clinical efficacy of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction(HFrEF) and heart failure with preserved ejection fraction(HFpEF), and to analyze its effect on right ventricular structure and function and the occurrence of symptomatic hypotension. Methods One hundred and twenty patients with chronic heart failure admitted to Department of the Cardiology, the First Hospital of Qinhuangdao from August 2020 to March 2022 were retrospectively enrolled, and classified into HFrEF group(n=60) and HFpEF group(n=60) according to the left ventricular ejection fraction(LVEF). Based on standardized anti-heart failure therapy, all patients received sacubitril/valsartan. After 3 months of treatment, comparison was conducted on clinical efficacy, 6-min walking distance(6MWD), Minnesota Living with Heart Failure Questionnaire(MLHFQ), right ventricular structure and function related parameters [tricuspid annular plane systolic excursion(TAPSE), tissue Doppler-derived tricuspid lateral annular systolic velocity(S′), right ventricular fractional area change(RVFAC), right atrial diameter(RAD), right ventricular diameter(RVD)], and the incidence rate of symptomatic hypotension. Results Before treatment, there was no significant difference between the two groups in 6MWD, MLHFQ scores and RAD(P>0.05);TAPSE, S’ and RVFAC in HFrEF group were lower than those in HFpEF group, while RVD was higher than that in HFpEF group, the differences were statistically significant(P<0.05). After 3 months of treatment, within HFrEF group, an increase in TAPSE, S′ and RVFAC along with a decrease in RVD were observed after treatment, while only an increase in TAPSE was detected within HFpEF group, the differences were statistically significant(P<0.05). After 3 months of treatment, the overall treatment efficacy rate and 6MWD in HFrEF group were 95.00% and(421.6±44.1) m, which were notably larger than those in HFpEF group [83.33% and(403.2±42.5) m], MLHFQ scores in the HFrEF group were(31.6±7.9) points, which were lower than those in HFpEF group [(39.5±8.8) points], the differences were statistically significant(P<0.05). The incidence rate of symptomatic hypotension was 23.3% in HFrEF group, which was higher than that in HFpEF group(8.3%), the difference was statistically significant(P<0.05). Conclusion Sacubitril/valsartan is effective in both HFrEF and HFpEF patients, and can effectively improve right ventricular function. However, patients with HFrEF are more likely to have symptomatic hypotension, so blood pressure monitoring is of vital importance during treatment.