通过左心房和心室应变评估的逆向重构反映了沙库巴曲缬沙坦的治疗反应。
Reverse Remodeling Assessed by Left Atrial and Ventricular Strain Reflects Treatment Response to Sacubitril/Valsartan.
机构信息
Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Gyeonggi, South Korea.
Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
JACC Cardiovasc Imaging. 2022 Sep;15(9):1525-1541. doi: 10.1016/j.jcmg.2022.03.019. Epub 2022 May 11.
BACKGROUND
The left ventricular global longitudinal strain (LVGLS) and left atrial reservoir strain (LARS) are considered as sensitive and reliable markers of cardiac remodeling and function. However, their temporal changes during optimal management of heart failure with reduced ejection fraction (HFrEF) are unknown.
OBJECTIVES
This study investigated the time trajectories of the LARS and LVGLS in patients with HFrEF treated with angiotensin receptor-neprilysin inhibitors, and assessed whether the LARS and LVGLS could define left heart reverse remodeling (LHRR) and reflect the treatment response and prognosis.
METHODS
Using a retrospective cohort of patients with HFrEF prescribed sacubitril/valsartan, we assessed the time trajectories of the LVGLS and LARS in 409 patients (1,258 echocardiograms), and investigated their association with the occurrence of cardiovascular death and hospitalization for heart failure (HHF), after the determination of LHRR, during a median follow-up of 27.1 (IQR: 18.3-36.3) months.
RESULTS
Among patients with HFrEF prescribed sacubitril/valsartan, both the LVGLS and LARS improved over time. The improvements in the LVGLS and LARS were prominent within 6 months of sacubitril/valsartan treatment: the LVGLS improved from 10.2% (IQR: 7.9%-12.7%) to 13.9% (IQR: 10.5%-16.3%) (P < 0.001), and the LARS improved from 11.4% (IQR: 8.4%-15.6%) to 15.9% (IQR: 11.5%-21.4%) (P < 0.001). These improvements were larger among patients who did not experience the study outcome than in patients with events. Improvement in the LVGLS to ≥13% and LARS to ≥12.5% (ie, complete LHRR) was significantly associated with a lower risk of cardiovascular death and HHF, and this association was stronger than that of changes in other conventional echocardiographic parameters.
CONCLUSIONS
In patients with HFrEF treated with sacubitril/valsartan, the LVGLS and LARS were improved, typically within 6 months of treatment. Complete LHRR, defined by improvement in the LVGLS and LARS, can be an indicator of treatment response and prognosis.
背景
左心室整体纵向应变（LVGLS）和左心房储备应变（LARS）被认为是心脏重构和功能的敏感和可靠标志物。然而，它们在心衰射血分数降低（HFrEF）的最佳治疗期间的时间变化尚不清楚。
目的
本研究探讨了接受血管紧张素受体-脑啡肽酶抑制剂治疗的 HFrEF 患者的 LARS 和 LVGLS 的时间轨迹，并评估了 LARS 和 LVGLS 是否可以定义左心反向重构（LHRR）并反映治疗反应和预后。
方法
使用接受沙库巴曲缬沙坦治疗的 HFrEF 患者的回顾性队列，我们评估了 409 例患者（1258 次超声心动图）的 LVGLS 和 LARS 的时间轨迹，并在中位随访 27.1（IQR：18.3-36.3）个月后，研究了它们与心血管死亡和心力衰竭住院（HHF）发生之间的关联，确定 LHRR 后。
结果
在接受沙库巴曲缬沙坦治疗的 HFrEF 患者中，LVGLS 和 LARS 随时间推移而改善。沙库巴曲缬沙坦治疗后 6 个月内，LVGLS 和 LARS 的改善较为显著：LVGLS 从 10.2%（IQR：7.9%-12.7%）改善至 13.9%（IQR：10.5%-16.3%）（P<0.001），LARS 从 11.4%（IQR：8.4%-15.6%）改善至 15.9%（IQR：11.5%-21.4%）（P<0.001）。与发生事件的患者相比，未发生研究结局的患者的改善更大。LVGLS 改善至≥13%和 LARS 改善至≥12.5%（即完全 LHRR）与心血管死亡和 HHF 的风险降低显著相关，这种相关性强于其他常规超声心动图参数的变化。
结论
在接受沙库巴曲缬沙坦治疗的 HFrEF 患者中，LVGLS 和 LARS 得到改善，通常在治疗后 6 个月内。通过 LVGLS 和 LARS 改善定义的完全 LHRR 可以作为治疗反应和预后的指标。
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