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维立西呱对急性失代偿心衰的疗效及对不同LVDd患者LVEF的影响
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| 篇名： | 维立西呱对急性失代偿心衰的疗效及对不同LVDd患者LVEF的影响 |
| TITLE： | Clinical efficacy of vericiguat in the treatment of acute decompensated heart failure and its effects on LVEF of patients with different LVDd |
| 摘要： | 目的 观察维立西呱治疗急性失代偿心衰（HF）的临床疗效及其对不同左室舒张末期内径（LVDd）患者左室射血分数（LVEF）的影响。方法选取2022年9月至2023年5月在安庆市立医院住院的经静脉注射利尿剂或扩血管药物治疗病情稳定后予以维立西呱口服的急性失代偿HF患者，共52例。收集患者临床基线数据，记录并分析其治疗后1、6个月的血肌酐（Scr）、估算肾小球滤过率（eGFR）、N末端B型脑钠肽前体（NT-proBNP）、超声心动图指标（LVEF、LVDd）、堪萨斯城心肌病调查问卷（KCCQ）评分等。按是否为扩张型心肌病分为2个亚组，比较两亚组的基线数据；采用混合效应模型分析全人群和两亚组患者上述随访指标的变化情况。结果扩张型心肌病组患者的年龄显著小于非扩张型心肌病组，同时前者合并冠心病的患者比例更低、LVDd更长、LVEF水平更低、射血分数降低的HF患者更多（P＜0.05）。与基线值相比，治疗后1个月时，全人群、非扩张性心肌病组和扩张型心肌病组患者的KCCQ评分均显著升高（P＜0.001）；治疗后6个月时，全人群在KCCQ评分提升和lg（NT-proBNP）水平下降方面的差异均有统计学意义（P＜0.05）；两亚组患者的lg（NT-proBNP）水平均显著下降，KCCQ评分均显著升高（P＜0.05），但组间比较差异无统计学意义（P＞0.05）；两亚组患者的LVEF水平均显著提升（P＜0.05），且组间差异幅度达7.52%（P＝0.030）。混合效应模型结果显示，患者是否患有冠心病以及不同基线LVDd水平均有可能影响随访LVEF水平，其中冠心病对随访LVEF的提升有促进作用（P＝0.043），但是冠心病分组×时间的交互作用不显著（P＞0.05）；与基线LVDd≥62mm相比，基线LVDd≤61mm患者的LVEF提升速度更快（P＜0.05）。结论维立西呱能够改善急性失代偿HF患者的心功能，提高其生活质量，且不会对患者肾功能产生负面影响。该药对基线LVDd≤61mm的患者，尤其能够显著提升其LVEF水平。 |
| ABSTRACT： | OBJECTIVE To observe the efficacy of vericiguat in the treatment of acute decompensated heart failure （HF） and its effect on left ventricular ejection fraction （LVEF） in patients with different left ventricular end-diastolic internal diameters （LVDd）. METHODS A total of 52 patients with acute decompensated HF who were hospitalized in Anqing Municipal Hospital from September 2022 to May 2023 and were stabilized by intravenous injection of diuretics or vasodilators and then given vericiguat orally were selected. Clinical baseline data were collected， and blood creatinine （Scr）， estimated glomerular filtration rate （eGFR）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， echocardiographic indexes（LVEF， LVDd）， and Kansas City cardiomyopathy questionnaire （KCCQ） scores and so on were recorded and analyzed at 1 and 6 months after treatment. The patients were divided into two subgroups according to whether they had dilated cardiomyopathy or not， the baseline data were compared between the two subgroups， and the changes in the above follow-up indexes for the entire population and two subgroups of patients were analyzed by using mixed effect model. RESULTS Patients in the dilated cardiomyopathy group were significantly younger than those in the nondilated cardiomyopathy group， while the former had a lower proportion of patients with combined coronary artery disease， longer LVDd， lower LVEF levels， and more HF patients with reduced ejection fraction （P＜0.05）. Compared with baseline values， KCCQ scores were significantly higher in patients in the whole population， non-dilated cardiomyopathy group and dilated cardiomyopathy group at 1 month after treatment （P＜0.001）. The difference between the whole population in terms of elevated KCCQ scores and decreased lg（NT-proBNP） levels was statistically significant at 6 months after treatment （P＜0.05）； the levels of lg（NT-proBNP）of two subgroups were significantly decreased and KCCQ scores were significantly increased （P＜0.05）， but the difference was not statistically significant （P＞0.05）； LVEF levels of the patients E-mail：guangf4-508@163.com in both subgroups were significantly elevated （P＜0.05） and the difference between the subgroups amounted to 7.52% （P＝0.030）. Mixed effect model result showed that whether patients had coronary artery disease and different baseline levels of LVDd were likely to affect follow-up LVEF levels， with coronary artery disease contributing to follow-up LVEF elevation （P＝0.043）， but the coronary artery disease subgroup × time interaction was not significant （P＞0.05）；compared with patients with baseline LVDd ≥62 mm， patients with baseline LVDd≤61 mm had a faster LVEF improvement （P＜0.05）. CONCLUSIONS Vericiguat is able to improve cardiac function and quality of life in patients with acute decompensated HF without negatively affecting their renal function. The drug is able to significantly improve LVEF levels in patients with baseline LVDd ≤61 mm. |
| 期刊： | 2024年第35卷第11期 |
| 作者： | 章礼玲；顾崇怀；乔锐；项学军 |
| AUTHORS： | ZHANG Liling，GU Chonghuai，QIAO Rui，XIANG Xuejun |
| 关键字： | 维立西呱；心力衰竭；急性失代偿；扩张型心肌病；冠心病；左室射血分数；左室舒张末期内径 |
| KEYWORDS： | vericiguat； heart failure； acute decompensation； dilated cardiomyopathy； coronary heart disease； left vericiguat |
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