| Objective: This study mainly observed the changes of conventional echocardiographic parameters and global longitudinal strain(GLS)in patients with acute myocardial infarction combined with left ventricular dysfunction before and after treatment with sacubitril/valsartan.Other observations of the study included the difference of echocardiographic parameters in patients after the treatment of sacubitril/valsartan from those of the RAAS inhibitor group;and the feasibility of global longitudinal strain(GLS)as an evaluating indicator of left ventricular function in patients with acute myocardial infarction.Method: This study is a prospective cohort study,collecting 113 patients of acute myocardial infarction combined with left ventricular dysfunction,and recording their treatment programs.All patients were given basic treatments such as anti-platelet,anti-coagulation,statins.26 cases were treated with sacubitril/valsartan as the experimental group;62 cases were treated with RAAS inhibitor as the control group;and the remaining 25 cases were not treated with the above two types of drugs because of low blood pressure during the hospital.Compare the basic data,infarct location,surgical data and related laboratory tests of each group;evaluate the patient’s congestion status score(CS score)during hospitalization;record echocardiography within 24 hours after admission,and record the left ventricular end-systolic volume(LVESV),Left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),average e’(ventricular septum and free wall),and measured left ventricular global longitudinal strain(GLS)during hospitalization.The echocardiography should be reviewed during the short to medium follow-up(3-6 months)after discharge.Result:1、Compared with the control group,the experimental group has no statistical difference in the proportion of gender,age,history of diabetes,history of hypertension,history of smoking,dyslipidemia,and SYNTAX score.There are differences between the groups in the Killip classification,and the proportion of Killip>2 in the control group is higher.There are differences between groups in diseased blood vessels,and the proportion of LAD disease in the experimental group is higher.2、GLS,admission NT-proBNP,admission troponin,and first ultrasound LVEF value within 24 hours are all related to the congestion state during the hospital.When the LVEF value>40%,the correlation with the troponin level is no longer statistically significant.When the first super LVEF value>50%,the CS score is only related to GLS.3、Comparing the first echocardiographic indicators within 24 hours,there was no statistical difference in LVEDV between the experimental group and the control group(P>0.05).However,the LVESV and GLS of the experimental group were higher,while SV and LVEF were lower(P<0.05).4、After 3-6 months of treatment,the GLS,SV,and LVEF values of the experimental group showed a trend of improvement,but in the control group,SV showed no significant improvement after treatment.In terms of the magnitude of change,the improvement in SV of the experimental group was significantly better than that of the control group,which was statistically significant.GLS and LVEF between the two groups also have the same trend,but the results are not statistically different.5、The application of ARNI can significantly improve SV,while the short-term application of β-blockers and spironolactone has no obvious effect on the improvement of SV.Conclusion: GLS can assess the congestion state of patients with left ventricular dysfunction after acute myocardial infarction,and it is more meaningful in patients with preserved ejection fraction.The application of sacubitril/valsartan in patients with acute myocardial infarction combined with left ventricular dysfunction can improve SV,LVEF and GLS in the short-medium term(3-6 months),while SV improvement is particularly evident compared with application of RAAS inhibitors. |
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