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ST段抬高型心肌梗死患者早期开始使用沙库巴曲缬沙坦可改善心室重构。

Early initiation of sacubitril/valsartan in STEMI patients improves ventricular remodeling.

作者信息

Wang Hongyuan, Wang Yanping, Zhang Xinjun, Liu Qiuxian, Zhang Kun

机构信息

Department of Cardiology, Jiangshan People's Hospital Quzhou 450001, Zhejiang, China.

出版信息

Am J Transl Res. 2025 Jun 15;17(6):4754-4763. doi: 10.62347/NUKJ1589. eCollection 2025.

DOI:10.62347/NUKJ1589
PMID:40672602
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12261188/
Abstract

OBJECTIVE

To explore the effect of early administration (within 24 hours) of sacubitril/valsartan (Entresto) on left ventricular remodeling and prognosis in patients with ST-elevation myocardial infarction (STEMI).

METHODS

A retrospective study was conducted involving 150 STEMI patients diagnosed at Jiangshan People's Hospital between September 2021 and August 2023. Among them, 70 patients who received sacubitril/valsartan treatment were assigned as the observation group, and 80 patients treated with valsartan formed the control group. The echocardiographic parameters and biomarkers of cardiac injury were assessed in both groups.

RESULTS

The observation group exhibited improved left ventricular ejection fraction and reduced left atrial and ventricular diameters, along with a significant rise in stroke volume and reductions in left ventricular end-systolic and end-diastolic volumes. Cardiac injury biomarkers, including B-type natriuretic peptide and Troponin, significantly decreased in the observation group, while minimal changes were observed in the control group. Inflammatory markers, such as C-reactive protein, procalcitonin, and white blood cell count, were significantly reduced in the observation group. These findings underscore the efficacy of early sacubitril/valsartan treatment in improving outcomes for STEMI patients through enhanced ventricular function and reduced biomarkers of injury and inflammation.

CONCLUSION

Early initiation of sacubitril/valsartan in STEMI patients significantly improves ventricular remodeling, as evidenced by enhanced echocardiographic parameters and reduced biomarkers, without increasing adverse events or compromising renal function.

摘要

目的

探讨沙库巴曲缬沙坦(诺欣妥)早期给药(24小时内)对ST段抬高型心肌梗死(STEMI)患者左心室重构及预后的影响。

方法

进行一项回顾性研究,纳入2021年9月至2023年8月在江山市人民医院确诊的150例STEMI患者。其中,70例接受沙库巴曲缬沙坦治疗的患者被分配为观察组,80例接受缬沙坦治疗的患者组成对照组。评估两组的超声心动图参数和心脏损伤生物标志物。

结果

观察组左心室射血分数提高,左心房和心室直径减小,同时每搏输出量显著增加,左心室收缩末期和舒张末期容积减小。观察组中包括B型利钠肽和肌钙蛋白在内的心脏损伤生物标志物显著降低,而对照组变化极小。观察组中炎症标志物,如C反应蛋白、降钙素原和白细胞计数显著降低。这些发现强调了早期使用沙库巴曲缬沙坦治疗通过增强心室功能以及降低损伤和炎症生物标志物来改善STEMI患者预后的疗效。

结论

STEMI患者早期开始使用沙库巴曲缬沙坦可显著改善心室重构,超声心动图参数增强和生物标志物降低证明了这一点,且未增加不良事件或损害肾功能。

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本文引用的文献

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Sacubitril/Valsartan in Patients Hospitalized With Decompensated Heart Failure.沙库巴曲缬沙坦在射血分数降低的心力衰竭患者中的应用。
J Am Coll Cardiol. 2024 Mar 26;83(12):1123-1132. doi: 10.1016/j.jacc.2024.01.027.
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Diagnostic value of electrocardiographic indices in discriminating the culprit vessel based on the coronary dominancy in inferior acute myocardial infarction.基于下壁急性心肌梗死冠脉优势型鉴别罪犯血管的心电图指标的诊断价值
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Effect of Emergency Percutaneous Coronary Intervention Combined with Sacubitril and Valsartan on the Cardiac Prognosis in Patients with Acute Myocardial Infarction.急诊经皮冠状动脉介入治疗联合沙库巴曲缬沙坦对急性心肌梗死患者心脏预后的影响
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Circulation. 2022 Dec 6;146(23):1749-1757. doi: 10.1161/CIRCULATIONAHA.122.060841. Epub 2022 Nov 2.
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Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies.心肌梗死后左心室重构:病理生理学、影像学及新疗法
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Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction.心力衰竭伴射血分数保留患者的糖尿病和糖尿病前期。
Eur J Heart Fail. 2022 Mar;24(3):497-509. doi: 10.1002/ejhf.2403. Epub 2022 Jan 4.
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Effect of dapagliflozin on the rate of decline in kidney function in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial.达格列净对伴有和不伴有 2 型糖尿病的慢性肾脏病患者肾功能下降速率的影响:来自 DAPA-CKD 试验的预先指定分析。
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