吡非尼酮对特发性肺纤维化患者左室结构和功能超声心动图参数的影响

Shehab Al-Ansari, A. Borowski, Ali Fuad, Omar Alawadhi, Haris Riaz, Vikram Sharma, Nauman A. Khan, B. Southern, W. Tang
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摘要

摘要目的:吡非尼酮是一种治疗特发性肺纤维化(IPF)的新型抗纤维化药物。在动物模型中,它与减轻心肌纤维化和左心室收缩和舒张功能障碍有关。然而,其对人体左室力学的影响尚不清楚。本研究的目的是回顾性评价吡非尼酮对IPF患者左室功能和结构超声心动图参数的影响。方法:共纳入124例IPF患者:接受吡非尼酮治疗的患者64例(治疗组),未接受吡非尼酮治疗的患者60例(对照组),在4年的时间框架内进行了连续的预处理/基线和治疗后/随访超声心动图。比较治疗组和对照组左室功能(收缩、舒张、整体纵向应变)参数均值和左室结构(质量和体积指数)的变化。随后的亚组分析仅包括88例患者(47例治疗组,41例对照组),超声心动图显示基线心肌功能障碍(定义为射血分数≤45,或舒张功能障碍1期或以上),以及已知的临床诊断为充血性心力衰竭。为了考虑潜在的混杂因素,通过1:1倾向评分匹配(PSM)进行了二次调整分析。这产生了一个由62例患者组成的样本,其中56例患者属于亚组队列。结果:治疗组患者明显年轻化(69.4 vs. 77岁,p<0.001),用力肺活量明显低于对照组(69.9% vs. 80.6%, p = 0.005)。然而,在PSM后,两组之间的年龄统计数据具有可比性(72.18对72.15,p = 0.9)。在初步的未校正分析中,与对照组相比,吡非尼酮给药后左室功能和结构的任何平均参数均无统计学意义的变化。此外,在亚组队列中没有发现显著差异。这些发现在PSM的二次分析后被再次证实。结论:从超声心动图的角度来看,吡非尼酮对IPF患者的左室结构和功能没有显著影响,即使在心功能明显不全的患者中也是如此。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Pirfenidone on Echocardiographic Parameters of Left Ventricular Structure and Function in Patients with Idiopathic Pulmonary Fibrosis
Abstract Aim: Pirfenidone is a novel anti-fibrotic agent utilized in the treatment of idiopathic pulmonary fibrosis (IPF). It has been implicated in mitigating myocardial fibrosis and left ventricular (LV) systolic and diastolic dysfunction in animal models. However, its impact on LV mechanics in humans remains unknown. The aim of this study was to retrospectively evaluate the effects of pirfenidone on echocardiographic parameters of LV function and structure in patients with IPF. Methods: A total of 124 patients with IPF were included in this study: 64 patients treated with pirfenidone (treatment group) and 60 patients not taking pirfenidone (control group), who had serial pretreatment/baseline and posttreatment/follow-up echocardiograms done within a time frame of four years. Changes in the means of parameters of LV function (systolic, diastolic, and global longitudinal strain) and LV structure (mass and volume indices) were compared between the treatment and control groups. This was followed by a subgroup analysis that included only 88 patients (47 treated, 41 controls) with echocardiographic evidence of myocardial dysfunction at baseline (defined as an ejection fraction of ≤45, or diastolic dysfunction stage 1 or more) in addition to a known clinical diagnosis of congestive heart failure. To account for potential confounders, a secondary adjusted analysis by way of 1:1 propensity score matching (PSM) was carried out. This yielded a sample consisting of 62 patients with 56 patients in the subgroup cohort. Results: Patients in the treatment group were significantly younger (69.4 vs. 77 years, p<0.001) and had relatively lower forced vital capacity (69.9% vs. 80.6%, p = 0.005) in comparison to the control group. However, after PSM, the age demographics were comparable between both groups (72.18 vs. 72.15, p = 0.9). In the primary unadjusted analysis, there was no statistically significant change in any of the mean parameters of LV function and structure after pirfenidone administration when compared to the control group. Furthermore, no significant differences were noted in the subgroup cohort. Such findings were re-demonstrated after a secondary analysis with PSM. Conclusion: From an echocardiographic perspective, pirfenidone had no significant effects on LV structure and function in patients with IPF, even in patients with more overt cardiac dysfunction.
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