沙库巴曲缬沙坦及缬沙坦对射血分数轻度降低心力衰竭患者心脏结构的影响

Impact of sacubitril/valsartan and valsartan on cardiac structure in heart failure patients with mildly reduced ejection fraction

目的以超声心动图观察沙库巴曲缬沙坦及缬沙坦对射血分数轻度降低心力衰竭(HFmrEF)患者心脏结构的影响。方法前瞻性纳入244例接受超声心动图检查的HFmrEF患者,按1∶1比例将其随机分为沙库巴曲缬沙坦组(A组,n=122)及缬沙坦组(B组,n=122);比较2组基线资料及治疗1年后超声参数的变化;以多因素Cox回归模型分析基线超声资料与发生终点事件风险的关系。结果2组基线资料差异均无统计学意义(P均>0.05)。治疗1年后,2组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心房最大容积(LAV_(max))、左心室质量(LVM)、LVEDV指数(LVEDVI)、LVESV指数(LVESVI)、LAV_(max)指数(LAVI)及LVM指数(LVMI)均下降,A组下降程度均大于B组(P均<0.05)。以协方差分析校正基线特征后,2组主要终点(LVEDV、LVESV及LAVI)及次要终点(LVEDV、LVESV及LAV_(max))差异均有统计学意义(P均<0.05)。Cox回归模型显示,HFmrEF患者治疗前超声心动图所测LVEDV、LVESV、LAV_(max)、LVM、LVEDVI、LVESVI、LAVI及LVMI越大,则发生终点事件风险越高。结论沙库巴曲缬沙坦及缬沙坦均可在一定程度上改善HFmrEF患者心脏重构,前者效果更佳。

Objective To observe the impact of sacubitril/valsartan and valsartan on cardiac structure in patients with heart failure and mildly reduced ejection fraction(HFmrEF)using echocardiography.Methods Totally 244 HFmrEF patients who would undergo echocardiography were prospectively enrolled and randomly divided into sacubitril/valsartan group(group A,n=122)or valsartan group(group B,n=122)at the ratio of 1∶1.Baseline data and changes in ultrasonic indexes after one-year treatment were compared between groups.Multivariate Cox regression model was used to analyze the relationships of baseline ultrasonic data and the risk of endpoint events.Results No significant difference of baseline data was found between groups(all P>0.05).After one-year treatment,left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left atrial maximum volume(LAV_(max)),left ventricular mass(LVM),LVEDV index(LVEDVI),LVESV index(LVESVI),LAV_(max) index(LAVI)and LVM index(LVMI)decreased in both groups,and the descendent degrees in group A were greater than those in group B(all P<0.05).After correction for baseline characteristics using covariance analysis,significant differences of primary endpoint(LVEDV,LVESV,LAVI)and secondary endpoint(LVEDV,LVESV,LAV_(max))were found between groups(all P<0.05).Cox regression model showed that the larger the ultrasounic parameters including LVEDV,LVESV,LAV_(max),LVM,LVEDVI,LVESVI,LAVI and LVMI before treatment,the higher risk of endpoint events.Conclusion Both sacubitril/valsartan and valsartan could improve cardiac remodeling in patients with HFmrEF,and the former had better effect.