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Prognostic Usefulness of Myocardial Work in Patients With Heart Failure and Reduced Ejection Fraction Treated by Sacubitril/Valsartan.

沙库巴曲/缬沙坦治疗射血分数降低的心力衰竭患者心肌做功的预后有用性。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.03.031
  • 作者列表:"Bouali Y","Donal E","Gallard A","Laurin C","Hubert A","Bidaut A","Leclercq C","Galli E
  • 发表时间:2020-06-15
Abstract

:The noninvasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (major adverse cardiovascular events [MACEs]). This study aimed to evaluate the short- and medium-term effect of Sacubitril/Valsartan treatment on MW parameters and the prognostic value of MW in this specific group of patients. Seventy-nine patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28% ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mm Hg%, p <0.0001) and myocardial work efficiency (WE) [87 (78to 90) vs 90 (86 to 95), p <0.0001]. During FU (2.6 ± 0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LV ejection fraction and WE, global myocardial constructive work (CW) was the only predictor of MACEs [hazard ratio [HR] 0.99 (0.99 to 1.00), p = 0.04]. A CW <910 mm Hg identified patients at particularly increase risk of MACEs [HR 11.09 (1.45 to 98.94), p = 0.002, log-rank test p <0.0001]. In conclusion, in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan allows the prediction of MACEs.

摘要

: 通过压力-应变环路分析 (PSL) 对心肌做功 (MW) 的非侵入性评估是用于评价心肌性能的相对新的工具。沙库巴曲/缬沙坦是一种治疗射血分数降低的心力衰竭 (HFrEF) 的药物,其对减少心血管事件 (主要不良心血管事件 [MACEs]) 具有显著效果。本研究旨在评估沙库巴曲/缬沙坦治疗对该特定患者组的MW参数的短期和中期影响以及MW的预后价值。79例HFrEF患者 (平均年龄: 66 ± 12岁; 左室射血分数: 28% ± 9%) 被前瞻性纳入研究,并接受沙库巴曲/缬沙坦治疗。在基线以及沙库巴曲/缬沙坦治疗6个月和12个月后进行超声心动图检查。沙库巴曲/缬沙坦显著增加心肌构造功 (CW) (1023 ± 449 vs 1424 ± 484毫米Hg %,p <0.0001) 和心肌工作效率 (WE) [87 (78至90) vs 90 (86至95),p <0.0001]。在FU (2.6 ± 0.9年) 期间,13例 (16%) 患者发生了MACEs。在对LV大小、LV射血分数和WE进行校正后,整体心肌结构工作 (CW) 是MACEs的唯一预测因子 [风险比 [HR] 0.99 (0.99至1.00),p   =   0.04]。CW <910毫米Hg确定患者的MACEs风险特别增加 [HR 11.09 (1.45 ~ 98.94),p   =   0.002,时序检验p <0.0001]。总之,在接受全面背景 β 受体阻滞剂和矿物质皮质激素受体拮抗剂治疗的HFrEF患者中,沙库巴曲/缬沙坦诱导心肌CW和WE的显著改善。在这个群体中,在Sacubitril/缬沙坦开始之前估计CW允许预测MACEs。

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影响因子:2.41
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影响因子:1.67
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DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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