沙库巴曲缬沙坦对射血分数保留的心力衰竭患者右心结构及功能的影响分析

Influence of sakubatril-valsartan on structure and function of right heart in patients with heart failure with preserved ejection fraction

目的探讨沙库巴曲缬沙坦对射血分数保留的心力衰竭(HFpEF)患者右心结构及功能的影响。方法选取2020年8月至2022年6月于安徽医科大学附属合肥医院心内科门诊收治的120例HFpEF患者,根据随机数字表法分为观察组和对照组各60例,观察组应用沙库巴曲缬沙坦(50 mg,bid)治疗,对照组应用缬沙坦(50 mg,bid)治疗,比较观察组和对照组患者治疗后右心收缩功能、舒张功能指标的变化。结果治疗后,两组心肌做功指数(Tei index,Tei指数)较治疗前下降(P<0.05),右室面积变化分数(RVFAC)、三尖瓣环平面收缩期位移(TAPSE)、三尖瓣环侧壁收缩期峰流速(TAPSV)均较治疗前升高,其中观察组Tei指数较对照组下降,而RVFAC、TAPSE、TAPSV均较对照组升高(P<0.05)。同时肺动脉平均压(mPAP)、右心房容积指数(RAVI)、舒张期室间隔厚度(IVST)在缬沙坦或沙库巴曲缬沙坦治疗后均下降(P<0.05),右侧房室瓣环处心肌舒张早期峰值流速(Ve)/舒张晚期峰值流速(Va)较治疗前升高,其中观察组mPAP、RAVI、IVST均较对照组下降,Ve/Va较对照组升高(P<0.05)。结论沙库巴曲缬沙坦能有效改善HFpEF患者右心收缩及舒张功能,可通过降低炎症因子以及纤维化相关因子水平改善心室重构。

Objective To investigate the influence of sakubatril-valsartan on structure and function of right heart in patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients(n=120)were chosen and divided,according to random digital table,into observation group control group(each n=60)in Department of Cardiology of Hefei Hospital affiliated to Anhui Medical University from Aug.2020 to June 2022.The observation group was treated with sakubatril-valsartan(50 mg,bid)and control group was treated with valsartan(50 mg,bid).The changes of indexes of right ventricular systolic and diastolic functions were compared between 2 groups after treatment.Results After treatment,Tei index decreased(P<0.05),and right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE)and tricuspid annular peak systolic velocity(TAPSV)increased in 2 groups.The indexes of Tei index was lower,and RVFAC,TAPSE and TAPSV were higher in observation group than those in control group(P<0.05).After treatment,mean pulmonary artery pressure(mPAP),right atrial volume index(RAVI)and diastolic interventricular septal thickness(IVST)decreased(P<0.05),and ratio of early diastole peak flow velocity at atrioventricularannulus(Ve)to late diastolic peak flow velocity at atrioventricular annulus(Va,Ve/Va)increased in 2 groups.The indexes of mPAP,RAVI and IVST were lower and Ve/Va was higher in observation group than those in control group(P<0.05).Conclusion Sakubatril-valsartan can effectively improve right ventricular systolic and diastolic functions,and relieve ventricular remodeling through reducing levels of inflammatory factors and fibrosis-related factors in HFpEF patients.