沙库巴曲缬沙坦与达格列净联合应用对左心疾病相关肺动脉高压患者右心室功能的影响  

Effect of Sacubitril/valsartan combined with dapagliflozin on right ventricular function in patients with pulmonary hypertension associated with left heart disease

作　　者：赵颖 马涛[1] 张立欣[1] 田立国[1] 邸亮 汪雁博[2] 谷新顺[2] 王丹丹 高尚 朱小玲 Zhao Ying;Ma Tao;Zhang Lixin;Tian Liguo;Di Liang;Wang Yanbo;Gu Xinshun;Wang Dandan;Gao Shang;Zhu Xiaoling(Department of Cardiology,Qinhuangdao Haigang Hospital,Qinhuangdao 066000,China;不详)

机构地区：[1]秦皇岛市海港医院心内科,秦皇岛066000 [2]河北医科大学第二医院心内科,石家庄050000

出　　处：《中国循证心血管医学杂志》2023年第8期958-961,966,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省医学科学研究课题计划(20221623)。

摘　　要：目的 本研究旨在研究沙库巴曲缬沙坦与达格列净联合应用对左心疾病相关肺动脉高压患者右心室功能的影响。方法 研究纳入2021年6月至2022年12月于秦皇岛海港医院心内科住院的射血分数减低心衰(HFr EF)导致的肺动脉高压(PH)患者。随机分为观察组和对照组,观察组逐步滴定沙库巴曲缬沙坦至100 mg,2/d,达格列净10 mg,1/d。对照组依那普利逐渐滴定至10 mg,1/d,达格列净10 mg1/d。记录入院后基线资料及治疗6个月后超声心动图检查数据,如左心房(LA)、左心室(LV)、左心室射血分数(LVEF)、三尖瓣环平面收缩期偏移(TAPSE)、三尖瓣环峰值速度(S’)、面积变化分数(FAC)、肺动脉收缩压(sPAP)等并计算TAPSE/sPAP,比较各项参数,并对随访6个月后主要心脏不良事件(MACE)进行比较。结果 两组患者基线特征无显著差异。治疗6个月后,观察组LVEF、S’、FAC、TAPSE、TAPSE/sPAP高于对照组,LA、LV、LVESV、sPAP、PA/AO低于对照组,差异有统计学意义(P<0.05);观察组NT-proBNP、心率、SBP、DBP低于对照组,6MWD高于对照组,差异有统计学意义(P<0.05)。两组患者治疗天数、治疗6个月内死亡情况、再住院情况比较,差异无统计学意义(P>0.05)。结论 沙库巴曲缬沙坦与达格列净联合应用对左心疾病相关肺动脉高压患者右心室功能有明显改善作用。Objective This study aimed to investigate the impact of combined administration of Sacubitril/valsartan and dapagliflozin on right ventricular function in patients with pulmonary hypertension associated with left heart disease.Methods The study included patients with pulmonary hypertension(PH) caused by heart failure with reduced ejection fraction(HFr EF) who were hospitalized in the Cardiology Department of Haigang Hospital,Qinhuangdao,between June 2021 and December 2022.The patients were randomly assigned to either the observation group or the control group.The observation group received gradual titration of sacubitril/valsartan up to 100 mg 2/d and dapagliflozin 10 mg 1/d.The control group received gradual titration of enalapril up to 10 mg 1/d and dapagliflozin 10 mg 1/d.Baseline data and echocardiographic examination data were recorded after 6 months of treatment,including left atrium(LA),left ventricle(LV),left ventricular ejection fraction(LVEF),tricuspid annular plane systolic excursion(TAPSE),tricuspid annular velocity(S'),fractional area change(FAC),systolic pulmonary artery pressure(sPAP),and TAPSE/sPAP.Major adverse cardiac events(MACE) were compared after a 6-month follow-up.Results There were no significant differences in baseline characteristics between the two groups.After 6 months of treatment,the observation group showed higher LVEF,S',FAC,TAPSE,and TAPSE/sPAP compared to the control group,while LA,LV,LVESV,sPAP,and PA/AO were lower in the observation group compared to the control group.These differences were statistically significant(P<0.05).The observation group also exhibited lower levels of NT-proBNP,heart rate,SBP,DBP,and higher 6-minute walking distance(6MWD) compared to the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in treatment duration,mortality,or rehospitalization within 6 months between the two groups(P>0.05).Conclusion The combined administration of Sacubitril/valsartan and dapagliflozin significantly improves

关 键 词：射血分数减低的心力衰竭 沙库巴曲缬沙坦 PH-LHD 右心室 

分 类 号：R541.61[医药卫生—心血管疾病]