Prognostic Usefulness of Myocardial Work in Patients With Heart Failure and Reduced Ejection Fraction Treated by Sacubitril/Valsartan.
- 作者列表："Bouali Y","Donal E","Gallard A","Laurin C","Hubert A","Bidaut A","Leclercq C","Galli E
: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.
: 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。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.