Effect Of Sacubitril/Valsartan(SV) On Left Atrial Structure And Function Of Patients With Chronic Heart Failure

Objective:Sacubitril/valsartan(SV)was used to treat patients with chronic heart failure(CHF),and its effects on left atrial structure and function were evaluated by real-time threedimensional echocardiography(RT-3DE)and two-dimensional speckle tracking(2DSTI).Methods:A total of 40 patients with chronic heart failure who were treated with SV in Qingdao Municipal Hospital were collected.The basic clinical information of the patients was recorded.The median follow-up time was 6 months.The baseline and follow-up general clinical data and echocardiographic parameters were collected.1.General clinical data.Age,gender,body mass index(BMI),systolic blood pressure,diastolic blood pressure,heart rate,complications,treatment regimen,SV dose,B-type N-terminal natriuretic peptide(NT-proBNP),serum creatinine,estimated glomerular filtration rate(eGFR)and serum potassium were recorded.2.The parameters of conventional echocardiography.Left atrial anterior-posterior diameter(LAD),left ventricular end-diastolic anteriorposterior diameter(LVD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF),right atrial left and right diameter(RAD),right ventricular left and right diameter(RVD)were recorded before and after follow-up.Left ventricular mass index(LVMI),E/A,E/e’ and diastolic function grade(DD grade)were calculated.Pulmonary artery systolic pressure(sPAP)was estimated.3.The measurement parameters of 2D-STI and RT-3DE.Using aCMQ strain analysis software,the overall longitudinal strain(LA-LS)of left atrium was analyzed,and the corresponding strain cow’s eye diagram was obtained.Using the 3DQ Advance analysis model,the time-volume curve of left atrial was obtained automatically.The maximum volume(LAVmax),minimum volume(LAVmin)and precontraction volume(LAVpreA)of the left atrium were measured.Calculate the corresponding left atrial volume indexed for BSA(LAVI)and calculate the left atrial global ejection fraction(LAEF),passive ejection fraction(LAPEF),active ejection fraction(LAAEF).All these parameters were recorded before and after follow-up.Results:1.The results of general clinical data before and after follow-up.The cardiac function grades of New York Heart Association(NYHA)were significantly improved,the levels of NT-proBNP,eGFR and BMI were significantly decreased after treatment(all P<0.05).No significant changes in blood pressure,serum potassium and serum creatinine were observed.2.The results of routine echocardiographic parameters before and after follow-up.After 6 months’ treatment,LVEF was significantly improved,LVD,LAD and LVMI were significantly decreased(P<0.05).E/e’ was decreased,DD grade was improved significantly(P<0.05).RAD was lower than before(P<0.05).there was no significant difference in IVST,LVPWT,E/A,sPAP and other indexes.3.The comparison of 2D-STI and RT-3DE parameters.During the follow-up,the left atrial volume:LAVmax,LAVmin,LAVpreA decreased significantly,and the left atrial volume indexed for BSA:LAVImax,LAVImin,LAVIpreA also decreased.The LAEF and LA-LS reflecting the overall and storage function of left atrium,the LAPEF reflecting conduit function and the LAAEF reflecting auxiliary pump function were significantly improved(all P<0.05).4.Correlation analysis and logistic regression analysis.Compared with the change rate of LAVImax and LA-LS,the change rate of LAEF during follow-up was positively correlated with the change rate of LVEF and E/e’(P<0.05).The correlation was better than others.According to the occurrence of left atrial reverse remodeling(LARR),the patients were divided into LARR group(n=25,62.5%)and nLARR group(n=15,37.5%).Univariate and multivariate logistic regression analysis showed that the course of disease and smoking history were statistically significant as independent variables,and the OR values were both<1,that is,the patients with shorter duration of heart failure or no smoking habit were more likely to realize the reverse of left atrial remodeling(P<0.05).Conclusion:1.While improving the clinical symptoms of chronic heart failure,increasing LVEF,decreasing LVD and reversing left ventricular remodeling,sacubitril/valsartan can also reduce LAD,LAVI and increase LAEF,reverse cardiac remodeling and improve left atrial function.2.LAEF is closely related to the factors related to left ventricular filling dysfunction and can be used as one of the indexes to evaluate cardiac function.3.Starting ARNI therapy as early as possible in the process of HF disease can better exert its benefits in reversing cardiac remodeling and improving cardiac function.