| Background Hypertension can cause the serious damage of many target organs including the heart.At present,the prevention situation of Chinese hypertension patient is still severe.Sacubitril/valsartan can simultaneously enhance the function of NPs and inhibit RAAS to achieve multi-channel hypotension,while effectively protecting important target organs of human body.However,various morphological parameters of the left ventricle in early hypertensive patients treated with Sacubitril/valsartan have not been significantly improved,so we cannot know whether there are changes in left ventricular myocardial remodeling or left ventricular function in hypertensive patients at this time,which may bias the early efficacy and prognosis evaluation of this drug.Based on two-dimensional spot tracking technology,LV-PSL can effectively fit left ventricular myocardial strain and afterload pressure,which can simultaneously reflect small left ventricular myocardial deformation and left ventricular afterload changes.It is an emerging technology that can quantitatively and sensitively reflect left ventricular myocardial function in hypertensive patients.Objective LVPSL is used to evaluate the changes in left ventricular function of Sacubitril/valsartan in patients with essential hypertension at the early stage of treatment,and to explore the clinical application value of LVPSL in the evaluation of left ventricular function in patients with essential hypertension.Methods This study was a cohort study.After approval by the ethics committee of our hospital,60 inpatients with essential hypertension who met the inclusion criteria were collected in our hospital from April 2022 to December 2022.According to the intake of sacubitril/valsartan or valsartan,the subjects were divided into ARNI group(n=30,sacubitril/valsartan sodium tablets 200 mg once daily,oral)and ARB control group(n=30,valsartan capsules 80 mg once daily,oral).The end point of the study was the 24 th week after treatment.The general data,conventional echocardiography and LVPSL parameters of hypertensive patients before treatment,12 th week and 24 th week after treatment were compared between the two groups.Global myocardial Work Index(GWI),Global myocardial Constructive Work(GCW),Global myocardial Wasted Work(GWW),Global myocardial Work Efficiency(GWE);LVPSL parameters,Left Ventricular Global Longitudinal Strain(LVGLS),Systolic Blood Pressure(Systolic Blood Pressure,SBP)of the two groups were analyzed.SBP),Left Atrial Sphericity Index(LASI),Left Atrial Volume Index(LAVI)and left ventricular diastolic dysfunction index E\e;Binary Logistic regression was used to analyze whether LVPSL parameters were risk factors for left ventricular diastolic dysfunction.Results(1)Comparison of baseline data between the experimental group and the control group: there was no significant difference in age,gender,body surface area,heart rate,systolic blood pressure and diastolic blood pressure between the two groups(P > 0.05).There was no significant difference in the parameters of conventional echocardiography(P > 0.05).There was no significant difference in LVPSL parameters between the two groups(P > 0.05).(2)After 12 weeks of treatment,the systolic blood pressure of the experimental group was significantly lower than that of the control group(P < 0.05),and there was no significant difference in diastolic blood pressure between the two groups(P > 0.05).Conventional echocardiographic parameters: e in the experimental group was significantly higher than that in the control group,E/e and LASI were significantly lower than those in the control group(P< 0.05).There were no significant differences in EF value,E,LVDD,LVSD,IVS,LVPW,AAOD,LAVI and LAD between the two groups.LVPSL parameters: GLS and GWE in the experimental group were significantly higher than those in the control group,and GWW was significantly lower than that in the control group(P < 0.05).There was no significant difference in GWI and GCW between the two groups(P > 0.05).(3)After 24 weeks of treatment,the systolic blood pressure of the experimental group was significantly lower than that of the control group(P < 0.05),and there was no significant difference in diastolic blood pressure between the two groups(P > 0.05).e in the experimental group was significantly higher than that in the control group,and E/e,LASI,and LAVI were significantly lower than those in the control group(P < 0.05).There was no significant difference in EF value,E,LVDD,LVSD,IVS,LVPW,AAOD,and LAD between the two groups(P > 0.05).GLS and GWE in the experimental group were significantly higher than those in the control group,and GWW was significantly lower than that in the control group(P < 0.05).There was no significant difference in GWI and GCW between the two groups(P > 0.05).(4)Compared with the baseline,the systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the patients were significantly decreased at 12 and 24 weeks after treatment(P < 0.05).Compared with baseline,e was significantly increased,E/e and LASI were significantly decreased at12 W and 24 W after treatment,and LAVI was significantly different at 24 W after treatment(P< 0.05).There were no significant differences in EF,E,LVDD,LVSD,IVS,LVPW,AAOD and LAD between the two groups(P > 0.05).Compared with the baseline,GLS and GWE of the patients treated for 12 and 24 weeks were significantly increased,and GWI,GCW and GWW were significantly decreased(P < 0.05).(5)In the control group,the systolic blood pressure(SBP)and diastolic blood pressure(DBP)at 12 and 24 weeks after treatment were significantly lower than those at baseline(P<0.05).Compared with baseline,E was significantly increased and E/e was significantly decreased at 24 weeks after treatment(P <0.05),while EF,E,LVDD,LVSD,IVS,LVPW,AAOD,LASI,LAVI,and LAD were not significantly different(P > 0.05).Compared with the baseline,the GWE of the patients on the24 th week of treatment was significantly increased,and the GWI,GCW and GWW of the patients on the 12 th and 24 th week of treatment were significantly decreased(P < 0.05),while the GLS showed an increasing trend,but the difference was not statistically significant(P >0.05).(6)Pearson correlation analysis for correlation test: SBP,GWW,LAVI were positively correlated with E/e(r=0.31,0.58,0.48,P < 0.05),GWE was negatively correlated with E/e(r=-0.53,P < 0.05),GLS,GWI,GCW,LASI were not significantly correlated with E/e.(7)Binary Logistic regression analysis: In this study,the index of left ventricular diastolic dysfunction E/e was used as the dependent variable,and SBP,GWW and LAVI were used as independent variables for binary Logistic regression analysis.The results showed that GWW was an independent risk factor for left ventricular diastolic dysfunction.Conclusion(1)In the early stage of use,Sacubitril/valsartan can significantly reduce the left ventricular GWW,increase the GWE,and effectively improve the left ventricular myocardial function.(2)LVPSL has certain clinical application value in evaluating left ventricular myocardial function in patients with hypertension. |
PDF Full Text Request