Correale Michele, D'Alessandro Damiano, Tricarico Lucia, Ceci Vincenzo, Mazzeo Pietro, Capasso Raffaele, Ferrara Salvatore, Barile Massimo, Di Nunno Nicola, Rossi Luciano, Vitullo Antonio, Granatiero Michele, Granato Mattia, Iacoviello Massimo, Brunetti Natale Daniele
Cardiothoracic Department, Ospedali Riuniti University Hospital, Foggia, Italy.
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Int J Cardiol Heart Vasc. 2024 Aug 20;54:101492. doi: 10.1016/j.ijcha.2024.101492. eCollection 2024 Oct.
Cardiac remodeling is an adverse phenomenon linked to heart failure (HF) progression. Cardiac remodeling could represent the real therapeutic goal in the treatment of patients with HF and reduced ejection fraction (HFrEF), being potentially reversed through different pharmacotherapies. Currently, there are well-established drugs such as ACEi/ARBs and β-blockers with anti-remodeling effects. More recently, ARNI effects on cardiac remodeling were also demonstrated; additional potential benefits of gliflozins remain non clearly demonstrated.
To evaluate possible changes in cardiac remodeling in patients with HFrEF/HFmrEF in treatment with ARNI or ARNI plus SGLT2i and the potential benefit on cardiac remodeling of adding SGLT2i to ARNI.
Between June 2021 and August 2023, 100 consecutive patients with HFrEF/HFmrEF underwent conventional and advanced echocardiography (TDI, 2DSTE): patients were therefore divided into three groups according to therapy with neither ARNI nor SGLT2i, just ARNI or both. After 3 months, all patients underwent echocardiographic follow-up.
After a 3 months of therapy, significant improvements were observed for LVEF, LVEDD, LVEDV, LVESV, LV mass, E/e', LV GLS, TAPSE (ANOVA p< 0.01 in all cases), RV S' velocity (ANOVA p< 0.001).The trend in favor of additional treatment with SGTL2i over ARNI remained statistically significant even after multivariable analysis (p< 0.001 for LVEF, LVEDD; p< 0.01 for LV GLS, TAPSE, TRVS; p< 0.05 for LV mass).
SGLT2i therapy when added to the standard treatment for HFrEF and HFmrEF is associated with an improved biventricular function and ventricular dimensions at follow-up.
心脏重塑是一种与心力衰竭（HF）进展相关的不良现象。心脏重塑可能是射血分数降低的心力衰竭（HFrEF）患者治疗的真正目标，通过不同的药物治疗可能会逆转。目前，有一些已确立的具有抗重塑作用的药物，如ACEi/ARB和β受体阻滞剂。最近，也证实了ARNI对心脏重塑的作用；格列净的额外潜在益处仍未明确证实。
评估使用ARNI或ARNI加SGLT2i治疗的HFrEF/HFmrEF患者心脏重塑的可能变化，以及在ARNI中添加SGLT2i对心脏重塑的潜在益处。
在2021年6月至2023年8月期间，100例连续的HFrEF/HFmrEF患者接受了传统和高级超声心动图检查（TDI、2DSTE）：因此，根据是否使用ARNI和SGLT2i，将患者分为三组，即既不使用ARNI也不使用SGLT2i、仅使用ARNI或两者都使用。3个月后，所有患者接受超声心动图随访。
治疗3个月后，左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室质量、E/e'、左心室整体纵向应变（LV GLS）、三尖瓣环平面收缩期位移（TAPSE）均有显著改善（所有病例方差分析p<0.01），右心室S'速度也有显著改善（方差分析p<0.001）。即使在多变量分析后，SGTL2i联合ARNI治疗优于ARNI单药治疗的趋势在统计学上仍具有显著意义（LVEF、LVEDD的p<0.001；LV GLS、TAPSE、TRVS的p<0.01；左心室质量的p<0.05）。
在HFrEF和HFmrEF的标准治疗中添加SGLT2i治疗与随访时双心室功能和心室大小的改善相关。
