沙库巴曲缬沙坦治疗后的心肌做功改善：新治疗的新超声心动图参数。
Myocardial work improvement after sacubitril-valsartan therapy: a new echocardiographic parameter for a new treatment.
机构信息
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
出版信息
J Cardiovasc Med (Hagerstown). 2020 Mar;21(3):223-230. doi: 10.2459/JCM.0000000000000932.
AIMS
Myocardial work is a new transthoracic echocardiogram (TTE) parameter that enhances the information provided through left ventricular (LV) global longitudinal strain (GLS). Nothing is known about the impact of sacubitril/valsartan (LCZ696) therapy on myocardial work parameters. The aim of this study was to evaluate the effects of LCZ696 on LV myocardial work in heart failure patients.
METHODS
Prospective evaluation of chronic heart failure patients with LV ejection fraction of 40% or less despite optimized standard of care therapy, in which LCZ696 therapy was started and no other heart failure treatment was expected to change. TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of LV GLS was made and myocardial work estimated using custom software of the GE Vivid E95 ultrasound system.
RESULTS
Of the 42 patients, 35 (83.3%) completed the 6 months, follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment due to adverse events. Mean age was 58.6 ± 11.1 years. TTE data showed a significant reduction in LV dimensions and atrial volumes, as well as an improvement in LV ejection fraction (29.3 vs. 35.2%, P = 0.001) and GLS (-7.0 vs. -8.9%, P = 0.001). Myocardial work had a significant increase in global constructive work (720.2 vs. 900.6 mmHg%, P = 0.016) and global work efficiency (78.6 vs. 86.6%, P = 0.027), with a nonsignificant decrease in global wasted work (150.2 vs. 136.8 mmHg%, P = 0.441) at 6 months.
CONCLUSION
LCZ696 therapy was associated with signs of reverse remodelling by usual TTE parameters and LV myocardial work at 6 months, including an increase in global constructive work and work efficiency.
目的
心肌做功是一种新的经胸超声心动图（TTE）参数，可增强通过左心室（LV）整体纵向应变（GLS）提供的信息。目前尚不清楚沙库巴曲缬沙坦（LCZ696）治疗对心肌做功参数的影响。本研究旨在评估 LCZ696 对心力衰竭患者 LV 心肌做功的影响。
方法
前瞻性评估 LV 射血分数（EF）为 40%或更低的慢性心力衰竭患者，尽管接受了最佳标准治疗，但开始使用 LCZ696 治疗，并且预计其他心力衰竭治疗不会改变。在 LCZ696 治疗前和治疗后 6 个月进行 TTE 研究。使用 GE Vivid E95 超声系统的自定义软件对 LV GLS 进行半自动分析，并估算心肌做功。
结果
42 例患者中，35 例（83.3%）完成了 6 个月的随访，因为 2 例（4.8%）患者死亡，5 例（11.9%）因不良事件停止治疗。平均年龄为 58.6±11.1 岁。TTE 数据显示 LV 尺寸和心房容积明显缩小，LV 射血分数（29.3%对 35.2%，P=0.001）和 GLS（-7.0%对-8.9%，P=0.001）均有改善。心肌做功的整体构建功（720.2 对 900.6mmHg%，P=0.016）和整体工作效率（78.6 对 86.6%，P=0.027）有显著增加，而整体浪费功（150.2 对 136.8mmHg%，P=0.441）无显著减少。
结论
LCZ696 治疗 6 个月后，通常 TTE 参数和 LV 心肌做功均显示出逆重构迹象，包括整体构建功和工作效率增加。
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