Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
Indian Heart J. 2021 Mar-Apr;73(2):205-210. doi: 10.1016/j.ihj.2021.01.010. Epub 2021 Jan 13.
Sacubitril/Valsartan (ARNI) has now class 1 recommendation for treatment of heart failure with reduced ejection fraction (HFrEF). It has been shown to reduce cardiovascular morbidity & mortality in Heart failure with reduced ejection fraction (HFrEF) and significant improvement in all echocardiographic parameters besides TEI index. Tei index is a marker of inflammation, myocardial cell metabolism and its contractile function has not been evaluated as a distinctive entity so we took up this study to evaluate the effects of ARNI on the LV functions using two dimensional (2D)ECHO parameters in Indian population and to assess TEI index for myocardial function.
256 patients with class II, III or IV HF and EF<40% were enrolled. 171(66.8%) were males and 85(33.2%) were females. Patients were evaluated at baseline, 6 and 12 months for LVEF, LV mass &,LVMPI. Drug was discontinued in 2 patients due to angioedema, in 5 patients due to acute kidney injury and in 2 patients due to hypotension. LV mass measurement done by linear echocardiographic method and Flow Doppler method used for TEI index calculation.
Baseline parameters in 247 patients were mean EF = 26.33 ± 6.28%, mean LV mass = 270.84 ± 68.94 gm, mean Tei Index = 0.852 ± 0.22. ARNI use was associated with an average gradual increase in EF, from a mean baseline of 26.33 ± 6.28% to 33.88 ± 7.73%(p = 0.000001) after 1 year of treatment. There was a significant progressive reduction of 57.97 g/m2 in mean LV mass index after 1 year of treatment (p = 0.000001).TEI index showed significant reduction from baseline mean 0.85 ± 0.22 to 0.70 ± 0.12(p = 0.000001)after 1 year of treatment.
Use of ARNI as additive adjunct to standard care of treatment resulted in significant progressive decline in LV mass and increase in TEI index.
沙库比曲缬沙坦（ARNI）现被列为 1 类推荐药物，用于治疗射血分数降低的心力衰竭（HFrEF）。临床试验已经证实，ARNI 可降低射血分数降低的心力衰竭（HFrEF）患者的心血管发病率和死亡率，并显著改善所有超声心动图参数，包括组织多普勒成像（TEI）指数。TEI 指数是炎症、心肌细胞代谢和收缩功能的标志物，但其作为一个独立的实体尚未得到评估，因此我们开展了这项研究，以评估在印度人群中使用二维（2D）ECHO 参数评估 ARNI 对左心室（LV）功能的影响，并评估 TEI 指数对心肌功能的影响。
共纳入 256 例射血分数（EF）<40%的 II 级、III 级或 IV 级心力衰竭患者。其中 171 例（66.8%）为男性，85 例（33.2%）为女性。在基线、6 个月和 12 个月时对患者的左心室射血分数（LVEF）、左心室质量（LV 质量）和左心室质量指数（LVMPI）进行评估。由于血管性水肿，2 例患者停止使用药物；由于急性肾损伤，5 例患者停止使用药物；由于低血压，2 例患者停止使用药物。采用线性超声心动图法测量 LV 质量，采用血流多普勒法计算 TEI 指数。
247 例患者的基线参数为平均 EF=26.33±6.28%，平均 LV 质量=270.84±68.94g，平均 TEI 指数=0.852±0.22。ARNI 的使用与 EF 的逐渐增加相关，从基线的 26.33±6.28%增加到治疗 1 年后的 33.88±7.73%（p=0.000001）。治疗 1 年后，LV 质量指数平均下降 57.97g/m2（p=0.000001）。TEI 指数从基线的 0.85±0.22 显著下降至 0.70±0.12（p=0.000001）。
ARNI 作为标准治疗的附加治疗，可显著降低 LV 质量，增加 TEI 指数。
