Sacubitril/valsartan on right ventricular-pulmonary artery coupling and albumin-bilirubin score in heart failure in Chinese patients with reduced ejection fraction.
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引用次数: 0
Abstract
Objective: Impaired right ventricular (RV)-pulmonary arterial (PA) coupling, calculated by measuring the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), can be used as an early indicator of right ventricular dysfunction (RVD) in patients with heart failure with a reduced ejection fraction (HFrEF). Patients suffering from HFrEF experience improvements in left ventricular (LV) function through the administration of sacubitril/valsartan therapy. In addition, the albumin-bilirubin (ALBI) score was associated with the fluid overload status and adverse clinical outcomes in patients with heart failure. This study aimed to assess whether angiotensin receptor-neprilysin inhibitor (ARNI) affects the TAPSE /PASP in patients with HFrEF, and whether there is a correlation between changes in the ALBI score and ARNI treatment.
Methods: A retrospective observational study was conducted on 305 patients with HFrEF and RVD who were hospitalized between June 2020 and December 2021. One year after treatment, laboratory test results, ALBI score, transthoracic echocardiography (TTE), New York Heart Association classification, Minnesota Living with Heart Failure Questionnaire scores and changes in relevant variables were reevaluated.
Results: Compared to before sacubitril/valsartan treatment, the ALBI was found to be significantly reduced after one year of follow-up (-2.42 ± 0.37 vs. -2.51 ± 0.32, p < 0.001). Additionally, A significant improvement was demonstrated in the following echocardiography parameters assessing RV function after 1 year of treatment with sacubitril/valsartan: TAPSE (15 ± 1 vs. 18 ± 2 mm, p < 0.001), PASP (45 ± 8 vs. 40 ± 9 mmHg, p < 0.001), pulmonary artery diastolic pressure (PADP) (22 ± 4 vs. 19 ± 4 mmHg, p < 0.001), RV-PA coupling (0.35 ± 0.08 vs. 0.48 ± 0.12, p < 0.001), and RV s'(8.7 ± 2.2 vs. 9.5 ± 2.6 cm/s, p < 0.001). Multivariate analysis showed that the improvement of RV-PA coupling was associated with baseline PASP (r: -0.45, p < 0.001) and PADP (r: -0.45, p < 0.001).
Conclusions: Sacubitril/valsartan improves RV-PA conjugation in patients with RVD and HFrEF, and has a positive impact on the ALBI score by improving liver function in patients with HFrEF.
目的：通过测量三尖瓣环平面收缩偏移（TAPSE）与肺动脉收缩压（PASP）的关系来计算右心室(RV)-肺动脉（PA）耦合受损，可作为心力衰竭伴射血分数降低（HFrEF）患者右心室功能障碍（RVD）的早期指标。HFrEF患者通过给予苏比里尔/缬沙坦治疗可改善左心室（LV）功能。此外，白蛋白-胆红素（ALBI）评分与心力衰竭患者的体液超载状态和不良临床结果相关。本研究旨在评估血管紧张素受体-neprilysin抑制剂（ARNI）是否影响HFrEF患者的TAPSE /PASP，以及ALBI评分的变化与ARNI治疗之间是否存在相关性。方法：对2020年6月至2021年12月住院的305例HFrEF和RVD患者进行回顾性观察研究。治疗后1年，重新评估实验室检查结果、ALBI评分、经胸超声心动图（TTE）、纽约心脏协会分级、明尼苏达州心衰生活问卷评分及相关变量变化。结果：与治疗前相比，随访1年后发现ALBI明显降低（-2.42±0.37 vs -2.51±0.32,p）。结论：sacubitril/缬沙坦改善RVD和HFrEF患者的RV-PA结合，并通过改善HFrEF患者的肝功能对ALBI评分有积极影响。
期刊介绍：
Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields.
Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials.
Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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