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通讯作者:

陈军红,E⁃mail:cjh1029@sina.com

中图分类号:R541.6

文献标识码:A

文章编号:1007-4368(2022)03-357-06

DOI:10.7655/NYDXBNS20220308

参考文献 1
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参考文献 2
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参考文献 3
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参考文献 4
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参考文献 5
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参考文献 7
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参考文献 8
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参考文献 9
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参考文献 10
ESPINOLA ⁃ ZAVALETA N,ANTONIO ⁃ VILLA N E,BRISEÑO⁃DIAZ N,et al.Left ventricular and atrial global strain evaluation within subtypes of ventricular remodeling [J].Echocardiography,2021,38(2):280-288
参考文献 11
TOPS L F,DELGADO V,MARSAN N A,et al.Myocardial strain to detect subtle left ventricular systolic dysfunction [J].Eur J Heart Fail,2017,19(3):307-313
参考文献 12
LANG RM,BADANO LP,MOR⁃AVI V,et al.Recommen⁃ dations for cardiac chamber quantification by echocar⁃ diography in adults:an update from the American Society of Echocardiography and the European Association of Car⁃ diovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.e14
参考文献 13
TAWFIK W,EL⁃SHERIF A,BENDARY A,et al.Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST ⁃ segment eleva⁃ tion myocardial infarction(STEMI)[J].Echocardiogra⁃ phy,2020,37(4):570-577
参考文献 14
MOGENSEN U M,GONG J,JHUND P S,et al.Effect of sacubitril/valsartan on recurrent events in the prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial(PAR⁃ ADIGM⁃HF)[J].Eur J Heart Fail,2018,20(4):760-768
参考文献 15
NIE D,XIONG B,QIAN J,et al.The effect of sacubitril⁃ valsartan in heart failure patients with mid⁃range and pre⁃ served ejection fraction:a meta ⁃analysis[J].Heart Lung Circ,2021,30(5):683-691
参考文献 16
TROMP J,KHAN M A F,MENTZ R J,et al.Biomarker profiles of acute heart failure patients with a mid ⁃ range ejection fraction[J].JACC Heart Fail,2017,5(7):507-517
参考文献 17
VERGARO G,AIMO A,PRONTERA C,et al.Sympathetic and renin ⁃ angiotensin ⁃ aldosterone system activation in heart failure with preserved,mid⁃range and reduced ejec⁃ tion fraction[J].Int J Cardiol,2019,296:91-97
参考文献 18
RICKENBACHER P,KAUFMANN B A,MAEDER M T,et al.Heart failure with mid⁃range ejection fraction:a dis⁃ tinct clinical entity?Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure(TIME ⁃ CHF)[J].Eur J Heart Fail,2017,19(12):1586-1596
参考文献 19
MCMURRAY J J,PACKER M,DESAI A S,et al.Angio⁃ tensin ⁃neprilysin inhibition versus enalapril in heart fail⁃ ure[J].N Engl J Med,2014,371(11):993-1004
参考文献 20
于越,许菲,周芳,等.沙库巴曲缬沙坦治疗射血分数降低心力衰竭患者的回顾性研究[J].南京医科大学学报(自然科学版),2020,40(5):697-701
参考文献 21
LIP G Y,SKJØTH F,OVERVAD K,et al.Blood pressure and prognosis in patients with incident heart failure:the Diet,Cancer and Health(DCH)cohort study[J].Clin Res Cardiol,2015,104(12):1088-1096
目录contents

    摘要

    目的:利用先进的斑点追踪超声技术评价射血分数中间值心衰(heart failure with mid⁃range ejection fraction,HFmrEF) 患者应用沙库巴曲缬沙坦治疗3个月后左心结构和功能变化。方法:选取2020年7月—2021年1月徐州医科大学附属医院就诊的射血分数在40%~49%之间的纽约心功能分级(NYHA)Ⅱ~Ⅲ级心衰患者共35例。二维斑点追踪超声评价初始及使用沙库巴曲缬沙坦治疗3个月后左室整体纵向应变(left ventricular global longitudinal strain,LVGLS)、左室各节段纵向应变达峰时间。Simpson 双平面法测量左室舒张末容积指数(left ventricular end⁃diastolic volume index,LVEDVI)、左室收缩末容积指数 (left ventricular end⁃systolic volume index,LVESVI)、左心房容积指数(left atrial volume index,LAVI)及左室射血分数(left ventric⁃ ular ejection fraction,LVEF)。彩色血流多普勒及组织多普勒测定舒张早期跨二尖瓣血流速度E峰与二尖瓣环速度e’的比值 (E/e’)。化学发光法测定血浆氨基末端脑钠肽前体(amino⁃terminal pro⁃brain natriuretic peptide,NT⁃proBNP)浓度。结果:沙库巴曲缬沙坦治疗3个月与基线相比:患者NYHA分级明显改善(P =0.008),NT⁃proBNP浓度明显降低(P < 0.001)。LVGLS较基线明显改善,左室各节段纵向应变达峰时间较基线明显缩短(P < 0.001)。常规超声指标LVEF较治疗前有所改善(P =0.001), LVEDVI及LVESVI较基线水平明显缩小(P < 0.001),LAVI及E/e’比值差异无明显统计学意义(P > 0.05)。结论:HFmrEF患者应用沙库巴曲缬沙坦3个月即可实现左心结构和功能的明显改善,斑点追踪超声基础上的应变及应变率分析是评价此类心衰患者左室重构的重要指标。

    Abstract

    Objective:This study aims to assess the cardiac structure and function in patients of heart failure with mid ⁃ range ejection fraction(HFmrEF)by speckling tracking echocardiography after 3 months sacubitril/valsartan treatment. Methods:A total of 35 patients with HFmrEF(EF range:40%~49%)and New York Heart Association(NYHA)class Ⅱ~Ⅲ were enrolled in this study from Jul 2020 to Jan 2021. In these patients,echocardiographic assessments were performed at the baseline and after 3 months sacubitril/valsartan therapy. The left ventricular(LV)global longitudinal strain(LVGLS)and the time to the peak strain were evaluated by using speckling tracking,the LV end ⁃diastolic volume index(LVEDVI),LV end ⁃systolic volume index(LVESVI),LV ejection fraction(LVEF)and left atrial volume index(LAVI)were acquired by Simpson’s method. Color and tissue Doppler ultrasound were utilized to get the ratio of early transmitral Doppler velocity/early diastolic annular velocity(E/e’). The level of serum amino ⁃ terminal pro ⁃ brain natriuretic peptide(NT ⁃ proBNP)was determined by electrochemiluminescence immunoassay method. Results: After the treatment,the NYHA function capacity class improved significantly(P =0.008),and the median NT ⁃proBNP concentration decreased significantly(P < 0.001). The LVGLS increased markedly compared with the baseline,and the time to peak longitudinal strain reduced significantly than the baseline(P < 0.001). There was a modest improvement in the LVEF(P =0.001). The LVEDVI and LVESVI decreased significantly compared with the baseline(P < 0.001). However,there was no significant change for LAVI and the E/ e’(both P > 0.05). Conclusion:In HFmrEF patients,3 months sacubitril/valsartan therapy could induce benefit on the left cardiac structure and function. Strain analysis based on speckling tracking echocardiography may act as a useful tool for assessment of the left ventricle remodeling in these patients.

  • 2016年欧洲心脏病学会首次将慢性心力衰竭中左室射血分数(left ventricular ejection fraction,LVEF)<40%的心衰命名为射血分数减低的心衰(heart failure with reduced ejection fraction,HFrEF),LVEF在40%~49%之间的心衰为射血分数中间值的心衰(heart failure with mid ⁃ range ejection fraction,HFmrEF)及LVEF≥50%的为射血分数保留型心衰(heart failure with preserved ejection fraction,HFpEF[1])。尽管已有文献报道沙库巴曲缬沙坦治疗HFmrEF及HFpEF患者心衰的有效性,但均局限于传统超声心动图指标,对反映左室重构的重要指标应变及应变率的研究较少。本研究对徐州医科大学附属医院初发心衰就诊的部分HFmrEF患者利用二维超声斑点追踪技术评价传统心衰治疗方案加用沙库巴曲缬沙坦3个月前后左室整体纵向应变(left ventricular global longitudinal strain,LVGLS)、左室各节段纵向应变达峰时间及常规超声心动图指标变化,为HFmrEF患者早期应用沙库巴曲缬沙坦逆转左室重构,改善临床症状及预后提供重要依据。

  • 1 对象和方法

  • 1.1 对象

  • 收集2020年7月—2021年1月徐州医科大学附属医院就诊的LVEF在40%~49%之间的心衰患者共35例。纳入标准:符合《中国心力衰竭诊断和治疗指南》(2018)HFmrEF诊断标准[2],LVEF在40%~49%之间,存在心力衰竭的临床症状或体征,血浆氨基末端脑钠肽前体(amino⁃terminal pro⁃brain natri⁃ uretic peptide,NT⁃proBNP)>125pg/mL,并至少符合以下1条:①左室肥厚和/或左房扩大。②心脏舒张功能异常。排除标准:①房颤伴极不规则的RR间期者;②频发的室上速或室性异位搏动者;③超声心动图透声窗差;④既往有血管性水肿病史者;⑤已知对血管紧张素受体拮抗剂或沙库巴曲缬沙坦过敏者;⑥肾小球滤过率(eGFR)<30mL/(min·1.73m2);⑦ 重度肝损害(Child⁃Pugh分级C级),胆汁性肝硬化和胆汁淤积;⑧血钾≥5.2mmol/L。本研究经徐州医科大学附属医院医学伦理委员会批准(XYFY2019⁃ KL209⁃01)。

  • 1.2 方法

  • 1.2.1 观察指标

  • 采用Philips EPIQ7C彩色多普勒超声诊断仪, S5⁃1矩阵探头,探头频率为2.0~3.5MHz,受试者同步连接心电图,存储受试者连续3~4个心动周期心内膜清晰的心尖三腔、心尖四腔及心尖两腔二维灰阶图像。Simpson双平面法测量左室舒张末容积指数 (left ventricular end⁃diastolic volume index,LVEDVI)、左室收缩末容积指数(left ventricular end ⁃ systolic volume index,LVESVI)、左心房容积指数(left atrial volume index,LAVI)及LVEF。各指标均采用美国超声心动图协会推荐的方法进行检测。基线及沙库巴曲缬沙坦治疗3个月应变分析采用Philips Qlab10.8实时分析软件,依次分析心尖三腔、心尖四腔及心尖两腔切面。启动aCMQ插件自动对整个心动周期的心室壁进行追踪,手动调整感兴趣区使其沿着心室壁走行并完整覆盖心内膜,计算后获得节段及整体纵向应变,进而获得左室各节段纵向应变达峰时间。血流多普勒超声测量二尖瓣口舒张早期血流速度峰值E峰,组织多普勒测量二尖瓣环间隔侧和游离壁侧舒张早期组织运动速度峰值的均值e’峰,E/e’比值作为评价左心室舒张功能的指标。电化学发光法测定血浆NT⁃proBNP浓度,单位pg/mL。

  • 1.2.2 治疗方案

  • 入组所有无相关用药禁忌证者,常规使用醛固酮受体拮抗剂和β受体阻断剂,部分存在水钠潴留的患者应用利尿剂,β受体阻断剂根据患者心率和血压均滴定至可耐受目标剂量。在上述治疗基础上加用沙库巴曲缬沙坦,采用滴定策略,起始剂量25~50mg,每日2次,每2~4周倍增剂量,至3个月左右所有患者根据血压情况逐渐滴定至100mg,每日2次。

  • 1.3 统计学方法

  • 使用SPSS 25.0统计软件进行所有统计学分析。对于计量资料,正态分布数据描述为均数±标准差(x-±s),组间数据比较采用配对样本t检验。计数资料以例数和构成比(%)表示,对于单向有序的多分类资料,采用配对秩和检验。所有检验均为双侧检验,P <0.05为差异有统计学意义。

  • 2 结果

  • 2.1 基本临床资料及特征变化

  • 本研究共纳入35例患者,其中男22例,女13例,年龄39~77岁,平均年龄(56.94±10.79)岁,纽约心脏病协会(NYHA)心功能分级Ⅱ~Ⅲ级,一般临床资料及基线特征见表1。与基线相比,沙库巴曲缬沙坦治疗3个月后,患者收缩压及舒张压均有下降,其中以收缩压下降更为明显[收缩压(138.94±14.49)mmHg vs.(122.23±16.55)mmHg,P <0.001;舒张压(74.83± 4.01)mmHg vs.(73.11 ± 4.61)mmHg,P=0.015,表1]。NYHA分级有所改善,差异有统计学意义(P=0.008,表2);心衰血清重要标志物NT⁃proBNP水平较基线显著降低(P <0.001,表3)。

  • 2.2 传统超声心动图指标比较

  • 服用沙库巴曲缬沙坦3个月后LVEDVI明显减少(P <0.001,表3);LVEF略有改善,由基线水平(44.37±2.45)%上升至(46.06±3.48)%,差异有统计学意义(P=0.001,表3);LAVI及E/e’差异无统计学意义(P均>0.05,表3)。

  • 表1 基线及沙库巴曲缬沙坦治疗3个月后的一般临床资料

  • Table1 Clinical characteristics of the baseline and follow⁃up after sacubitril/valsartan treatment for 3months

  • 表2 基线及沙库巴曲缬沙坦治疗3个月后的NYHA分级变化

  • Table2 NYHA functional classifications of baseline and follow ⁃ up after sacubitril/valsartan treatment for 3months

  • Z=-2.655,P=0.008。

  • 2.3 左室整体纵向应变及纵向应变达峰时间分析

  • 沙库巴曲缬沙坦治疗3个月后,LVGLS较基线明显改善(P <0.001,表3、图1),左室各节段纵向应变达峰时间较基线均明显缩短,差异均有统计学意义(P <0.001,表4)。

  • 3 讨论

  • HFmrEF患者作为一类特殊人群可以初始发病存在,也可以作为HFrEF治疗后症状改善及HFpEF患者心功能恶化的一个中间阶段[3-4]。2021年8月ESC最新关于急慢性心力衰竭诊断和治疗指南[5] (以下称‘新指南’)将原有的射血分数中间值心衰改名为“射血分数轻度降低的心衰(heart failure with mildly reduced ejection fraction,LVEF41%~49%)”,新指南指出按照LVEF进行心衰分类时不同类型心衰的临床特性、危险因素及心脏重构模式方面存在潜在重叠,在临床特性方面,HFmrEF患者与HFrEF更为相似。

  • 表3 服用沙库巴曲缬沙坦初始及3个月后左心功能参数变化

  • Table3 Left cardiac function parameters between baseline and follow⁃up after sacubitril/valsartan treatment for 3months

  • NT⁃proBNP:氨基末端脑钠肽前体;LVGLS:左室整体纵向应变;LVEDVI:左室舒张末容积指数;LVESVI:左室收缩末容积指数;LAVI:左心房容积指数;LVEF:左室射血分数;E/e’:舒张早期跨二尖瓣血流速度E峰与二尖瓣环速度e’的比值。

  • 图1 基线及沙库巴曲缬沙坦治疗3个月后左室各节段及整体纵向应变变化

  • Fig.1 Changes of the segmental and global longitudinal strain at baseline and after 3months of sacubitril/valsartan therapy

  • 心脏重构是慢性心力衰竭发生发展的主要病理基础,是心衰患者发病和死亡的决定因素,改善心脏重构是治疗慢性心衰的重要目标[6]。心脏重构定义为心脏几何形状和/或功能的任何改变,可能在持续的生理或病理生理学刺激、血液学变化以及炎症或神经激素激活时发生[7],当左室结构和/或功能恢复到接近正常心脏结构时,就会出现左室重构逆转,并与心脏功能改善和预后改善相关。由于评价方法和患者人群不同,目前对左室重构及重构逆转缺乏标准化定义[6],以往评价左室重构的指标主要包括LVEDVI、LVESVI及LVEF等[8-9],斑点追踪技术基础上的应变及应变率分析通过对感兴趣区域内心肌像素的跟踪,可精确反映心肌整体及节段在各个方向上收缩及舒张功能的微小变化,是近年来预测心室重构逆转的重要指标[10]。研究表明应变及应变率变化可早于正常的LVEF之前预测心衰患者亚临床阶段心肌功能的损害[11],尤其是LVGLS在评价左室收缩功能失调方面相比于LVEF敏感性更高,是预测心源性死亡、心衰住院率和恶性心律失常的综合指标[12]。Tawfik等[13] 证实在ST段抬高的心肌梗死患者中LVGLS可预测这类患者的心脏重构和不良临床事件。本研究通过对沙库巴曲缬沙坦治疗3个月前后传统超声指标及应变参数的分析,发现HFmrEF患者应用沙库巴曲缬沙坦短期即可出现LVGLS等左室重构指标的明显改善,差异较LVEF更为显著。

  • 沙库巴曲缬沙坦在心衰治疗领域带来了跨时代的变革,大型临床研究证实相比于血管紧张素转化酶抑制剂和血管紧张素受体拮抗剂类肾素⁃血管紧张素⁃醛固酮系统抑制剂,标准心衰治疗的基础上早期加用沙库巴曲缬沙坦可显著降低HFrEF患者的心血管死亡风险及再住院率[14]。但目前对于HFmrEF及HFpEF患者是否早期应用沙库巴曲缬沙坦即可实现重构逆转获益尚无一致性意见[15]。本研究针对HFmrEF这一类特殊人群,利用二维超声斑点追踪基础应变及应变率技术评价传统心衰药物联合沙库巴曲缬沙坦短期治疗3个月后LVGLS及峰值应变达峰时间变化,发现LVGLS较基线水平明显改善,峰值应变达峰时间明显缩短,差异较LVEF更为显著。左室纵向节段峰值应变达峰时间代表左室不同节段到达峰值应变的时间,是评价左室收缩协调性的重要指标。本研究发现HFmrEF患者应用沙库巴曲缬沙坦3个月左室各个节段应变达峰时间均明显缩短,说明此类患者应用沙库巴曲缬沙坦早期左室整体协调性可得到明显改善。

  • 表4 服用沙库巴曲缬沙坦初始及3个月后左室各节段纵向应变达峰时间

  • Table4 Time to peak systolic segmental strain of base⁃ line and follow ⁃ up after sacubitril/valsartan treatment for 3months

  • 在发病机制上,研究表明HFrEF主要受应力因素影响,HFpEF主要受炎症因素影响,HFmrEF病理生理机制则较为复杂,可能涉及牵拉应力和炎症等因素[16]。大部分研究表明HFmrEF在某些方面和HFrEF更具有相似性,发病机制中都包括神经激素激活且心衰标记物NT⁃proBNP都会有相似幅度的升高[17-18]。PARADIGM⁃HF研究中发现经沙库巴曲缬沙坦治疗的HFrEF患者NT⁃proBNP较常规心衰治疗方案患者下降更为明显[19],国内研究表明早期换用沙库巴曲缬沙坦可有效改善HFrEF患者NYHA心功能分级[20]。本研究中35例HFmrEF患者均为初次使用沙库巴曲缬沙坦,治疗3个月后NT⁃proBNP即出现明显下降,NYHA心功能分级明显改善,说明对于HFmrEF这一类特殊人群,初始使用沙库巴曲缬沙坦早期即可获益。

  • 沙库巴曲缬沙坦基于其独特的药理学作用,在改善心衰症状及预后的同时,对于血压影响较为显著。一项前瞻性队列研究表明,在患有心力衰竭的人群中,较高的基线收缩压和舒张压与不良事件发生率有关[21],这进一步支持了对该人群进行最佳血压控制的重要性,而对于HFmrEF/HFpEF患者,血压的控制尤为重要。本研究35例HFmrEF患者经过3个月沙库巴曲缬沙坦治疗后,收缩压与舒张压均出现下降趋势,但以收缩压降低更为显著,其改善心衰的同时表现出的降压作用对于急性心衰早期及基线血压较低患者可能有不利影响。故急性心衰及血压偏低的患者(收缩压≤90mmHg)未纳入本研究。

  • 既往研究发现HFrEF患者服用沙库巴曲缬沙坦6个月可以观察到LAVI及E/e’减小,表明此类患者左室舒张功能及左房功能得到明显改善。但本研究随访3个月后,LAVI及E/e’与基线相比差异并不显著,考虑可能与随访时间偏短、HFrEF患者本身较HFmrEF患者存在严重舒张功能不全有关,本研究例数偏少可能也是引起该结果的原因之一。

  • 新指南指出HFmrEF患者可以考虑使用沙库巴曲缬沙坦以降低心衰再住院率和死亡率[5]。这为临床HFmrEF患者早期使用沙库巴曲缬沙坦提供了指南依据。本研究存在以下局限性:首先,超声应变成像主要基于二维斑点追踪技术获得,它要求患者具有良好的透声声窗,对于透声窗不佳的患者,研究会有一定偏差。其次,对心律不齐的心衰患者尤其是房颤患者,应变及应变率的研究方法目前应用受限。最后,本研究样本量偏少,拟下一步增加样本量的同时比较超声和磁共振技术评价心衰患者应变的不同点,以期为心衰患者左室重构功能评价提供可靠依据。

  • 参考文献

    • [1] PONIKOWSKI P,VOORS A A,ANKER S D,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur J Heart Fail,2016,18(8):891-975

    • [2] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789

    • [3] KAPOOR J R,KAPOOR R,JU C,et al.Precipitating clini⁃ cal factors,heart failure characterization,and outcomes in patients hospitalized with heart failure with reduced,bor⁃ derline,and preserved ejection fraction[J].JACC Heart Fail,2016,4(6):464-472

    • [4] TSUJI K,SAKATA Y,NOCHIOKA K,et al.Characteriza⁃ tion of heart failure patients with mid⁃range left ventricu⁃ lar ejection fraction ⁃ a report from the CHART ⁃ 2 Study [J].Eur J Heart Fail,2017,19(10):1258-1269

    • [5] THERESA A M,MARCO M,MARIANNA A,et al.2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2021,42(36):3599-3726

    • [6] AIMO A,GAGGIN HK,BARISON A,et al.Imaging,bio⁃ marker,and clinical predictors of cardiac remodeling in heart failure with reduced ejection fraction[J].JACC Heart Fail,2019,7(9):782-794

    • [7] COHN JN,FERRARI R,SHARPE N.Cardiac remodeling ⁃ concepts and clinical implications:a consensus paper from an international forum on cardiac remodeling.Behalf of an International Forum on Cardiac Remodeling[J].J Am Coll Cardiol,2000,35(3):569-582

    • [8] MASCI PG,SCHUURMAN R,ANDREA B,et al.Myocar⁃ dial fibrosis as a key determinant of left ventricular remod⁃ eling in idiopathic dilated cardiomyopathy:a contrast⁃en⁃ hanced cardiovascular magnetic study[J].Circ Cardio⁃ vasc Imaging,2013,6(5):790-799

    • [9] LUPÓN J,GAGGIN HK,DE ANTONIO M,et al.Biomarker⁃ assist score for reverse remodeling prediction in heart fail⁃ ure:the ST2⁃R2 score[J].Int J Cardiol,2015;184:337-343

    • [10] ESPINOLA ⁃ ZAVALETA N,ANTONIO ⁃ VILLA N E,BRISEÑO⁃DIAZ N,et al.Left ventricular and atrial global strain evaluation within subtypes of ventricular remodeling [J].Echocardiography,2021,38(2):280-288

    • [11] TOPS L F,DELGADO V,MARSAN N A,et al.Myocardial strain to detect subtle left ventricular systolic dysfunction [J].Eur J Heart Fail,2017,19(3):307-313

    • [12] LANG RM,BADANO LP,MOR⁃AVI V,et al.Recommen⁃ dations for cardiac chamber quantification by echocar⁃ diography in adults:an update from the American Society of Echocardiography and the European Association of Car⁃ diovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.e14

    • [13] TAWFIK W,EL⁃SHERIF A,BENDARY A,et al.Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST ⁃ segment eleva⁃ tion myocardial infarction(STEMI)[J].Echocardiogra⁃ phy,2020,37(4):570-577

    • [14] MOGENSEN U M,GONG J,JHUND P S,et al.Effect of sacubitril/valsartan on recurrent events in the prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial(PAR⁃ ADIGM⁃HF)[J].Eur J Heart Fail,2018,20(4):760-768

    • [15] NIE D,XIONG B,QIAN J,et al.The effect of sacubitril⁃ valsartan in heart failure patients with mid⁃range and pre⁃ served ejection fraction:a meta ⁃analysis[J].Heart Lung Circ,2021,30(5):683-691

    • [16] TROMP J,KHAN M A F,MENTZ R J,et al.Biomarker profiles of acute heart failure patients with a mid ⁃ range ejection fraction[J].JACC Heart Fail,2017,5(7):507-517

    • [17] VERGARO G,AIMO A,PRONTERA C,et al.Sympathetic and renin ⁃ angiotensin ⁃ aldosterone system activation in heart failure with preserved,mid⁃range and reduced ejec⁃ tion fraction[J].Int J Cardiol,2019,296:91-97

    • [18] RICKENBACHER P,KAUFMANN B A,MAEDER M T,et al.Heart failure with mid⁃range ejection fraction:a dis⁃ tinct clinical entity?Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure(TIME ⁃ CHF)[J].Eur J Heart Fail,2017,19(12):1586-1596

    • [19] MCMURRAY J J,PACKER M,DESAI A S,et al.Angio⁃ tensin ⁃neprilysin inhibition versus enalapril in heart fail⁃ ure[J].N Engl J Med,2014,371(11):993-1004

    • [20] 于越,许菲,周芳,等.沙库巴曲缬沙坦治疗射血分数降低心力衰竭患者的回顾性研究[J].南京医科大学学报(自然科学版),2020,40(5):697-701

    • [21] LIP G Y,SKJØTH F,OVERVAD K,et al.Blood pressure and prognosis in patients with incident heart failure:the Diet,Cancer and Health(DCH)cohort study[J].Clin Res Cardiol,2015,104(12):1088-1096

  • 参考文献

    • [1] PONIKOWSKI P,VOORS A A,ANKER S D,et al.2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur J Heart Fail,2016,18(8):891-975

    • [2] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志,2018,46(10):760-789

    • [3] KAPOOR J R,KAPOOR R,JU C,et al.Precipitating clini⁃ cal factors,heart failure characterization,and outcomes in patients hospitalized with heart failure with reduced,bor⁃ derline,and preserved ejection fraction[J].JACC Heart Fail,2016,4(6):464-472

    • [4] TSUJI K,SAKATA Y,NOCHIOKA K,et al.Characteriza⁃ tion of heart failure patients with mid⁃range left ventricu⁃ lar ejection fraction ⁃ a report from the CHART ⁃ 2 Study [J].Eur J Heart Fail,2017,19(10):1258-1269

    • [5] THERESA A M,MARCO M,MARIANNA A,et al.2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2021,42(36):3599-3726

    • [6] AIMO A,GAGGIN HK,BARISON A,et al.Imaging,bio⁃ marker,and clinical predictors of cardiac remodeling in heart failure with reduced ejection fraction[J].JACC Heart Fail,2019,7(9):782-794

    • [7] COHN JN,FERRARI R,SHARPE N.Cardiac remodeling ⁃ concepts and clinical implications:a consensus paper from an international forum on cardiac remodeling.Behalf of an International Forum on Cardiac Remodeling[J].J Am Coll Cardiol,2000,35(3):569-582

    • [8] MASCI PG,SCHUURMAN R,ANDREA B,et al.Myocar⁃ dial fibrosis as a key determinant of left ventricular remod⁃ eling in idiopathic dilated cardiomyopathy:a contrast⁃en⁃ hanced cardiovascular magnetic study[J].Circ Cardio⁃ vasc Imaging,2013,6(5):790-799

    • [9] LUPÓN J,GAGGIN HK,DE ANTONIO M,et al.Biomarker⁃ assist score for reverse remodeling prediction in heart fail⁃ ure:the ST2⁃R2 score[J].Int J Cardiol,2015;184:337-343

    • [10] ESPINOLA ⁃ ZAVALETA N,ANTONIO ⁃ VILLA N E,BRISEÑO⁃DIAZ N,et al.Left ventricular and atrial global strain evaluation within subtypes of ventricular remodeling [J].Echocardiography,2021,38(2):280-288

    • [11] TOPS L F,DELGADO V,MARSAN N A,et al.Myocardial strain to detect subtle left ventricular systolic dysfunction [J].Eur J Heart Fail,2017,19(3):307-313

    • [12] LANG RM,BADANO LP,MOR⁃AVI V,et al.Recommen⁃ dations for cardiac chamber quantification by echocar⁃ diography in adults:an update from the American Society of Echocardiography and the European Association of Car⁃ diovascular Imaging[J].J Am Soc Echocardiogr,2015,28(1):1-39.e14

    • [13] TAWFIK W,EL⁃SHERIF A,BENDARY A,et al.Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST ⁃ segment eleva⁃ tion myocardial infarction(STEMI)[J].Echocardiogra⁃ phy,2020,37(4):570-577

    • [14] MOGENSEN U M,GONG J,JHUND P S,et al.Effect of sacubitril/valsartan on recurrent events in the prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial(PAR⁃ ADIGM⁃HF)[J].Eur J Heart Fail,2018,20(4):760-768

    • [15] NIE D,XIONG B,QIAN J,et al.The effect of sacubitril⁃ valsartan in heart failure patients with mid⁃range and pre⁃ served ejection fraction:a meta ⁃analysis[J].Heart Lung Circ,2021,30(5):683-691

    • [16] TROMP J,KHAN M A F,MENTZ R J,et al.Biomarker profiles of acute heart failure patients with a mid ⁃ range ejection fraction[J].JACC Heart Fail,2017,5(7):507-517

    • [17] VERGARO G,AIMO A,PRONTERA C,et al.Sympathetic and renin ⁃ angiotensin ⁃ aldosterone system activation in heart failure with preserved,mid⁃range and reduced ejec⁃ tion fraction[J].Int J Cardiol,2019,296:91-97

    • [18] RICKENBACHER P,KAUFMANN B A,MAEDER M T,et al.Heart failure with mid⁃range ejection fraction:a dis⁃ tinct clinical entity?Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure(TIME ⁃ CHF)[J].Eur J Heart Fail,2017,19(12):1586-1596

    • [19] MCMURRAY J J,PACKER M,DESAI A S,et al.Angio⁃ tensin ⁃neprilysin inhibition versus enalapril in heart fail⁃ ure[J].N Engl J Med,2014,371(11):993-1004

    • [20] 于越,许菲,周芳,等.沙库巴曲缬沙坦治疗射血分数降低心力衰竭患者的回顾性研究[J].南京医科大学学报(自然科学版),2020,40(5):697-701

    • [21] LIP G Y,SKJØTH F,OVERVAD K,et al.Blood pressure and prognosis in patients with incident heart failure:the Diet,Cancer and Health(DCH)cohort study[J].Clin Res Cardiol,2015,104(12):1088-1096

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