Effect of Dapagliflozin on Cardiac Structure and Function in Patients with Heart Failure Due to Mildly Reduced Ejection Fraction
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摘要:
目的 探讨达格列净对射血分数轻度下降性心力衰竭患者心脏结构及功能的影响。 方法 选取2021年11月1日至2022年12月31日在云南省第一人民医院门诊及住院确诊为射血分数轻度下降性心力衰竭的患者。根据是否服用达格列净将患者分为常规抗心衰组（41例）和达格列净组（44例）。常规抗心衰组进行常规的抗心衰治疗，达格列净组在常规抗心衰治疗（袢利尿剂、ACEI/ARB/ARNI、螺内酯、β受体阻滞剂）的基础上给予口服达格列净。观察2组治疗后3个月、6个月、1 a患者的心功能改善情况、LVEDD（左室舒张末期内径）、LVESD（左室收缩末期内径）、LVEF（左室射血分数）、IVST（室间隔厚度）、LVPWT（左室后壁厚度）、LAD（左房内径）及1 a内不良事件发生率。 结果 达格列净组33例、常规抗心衰组37例完成随访。（1）随访3月、6月、1 a，2组患者的NYNH心功能分级均较治疗前有所改善，达格列净组总有效率显著大于常规抗心衰组（P < 0.05）；（2）2组患者LVEF均较基线升高，LVEDD、LVESD、LAD、IVST、LVPWT均较基线下降（P < 0.05）；（3）3月LVEF、LVEDD、LVESD、LAD、IVST 2组比较无明显差异（P > 0.05），达格列净组LVPWT下降明显高于常规抗心衰组（P < 0.05）；（4）治疗6月及1 a，达格列净组LVEF升高程度，LAD、IVST、LVPWT下降程度明显高于常规抗心衰组（P < 0.05）；治疗6月2组LVEDD、LVESD下降程度比较无统计学意义（P > 0.05），治疗1 a比较有统计学意义（P < 0.05）。 结论 在规范化抗心力衰竭药物治疗基础上，联合达格列净可以进一步改善射血分数轻度下降性心力衰竭患者的心脏重塑及心脏功能。 -
关键词:
- 达格列净 /
- 射血分数轻度下降性心力衰竭 /
- 心脏重塑 /
- 心脏功能
Abstract:Objective To investigate the effects of dapagliflozin on cardiac structure and function in patients with heart failure due to mildly reduced ejection fraction. Methods Patients diagnosed with heart failure due to mildly reduced ejection fraction in the outpatient department and inpatient department of the First People's Hospital of Yunnan Province from November 1, 2021 to December 31, 2022 were selected and divided into the conventional anti-heart failure group and dapagliflozin group according to whether they were taking dapagliflozin or not. The conventional anti-heart failure group received the conventional anti-heart failure treatment （loop diuretics, ACEI/ARB/ARNI, spironolactone, β-blocker）, and the dapagliflozin group was given oral dapagliflozin on the basis of conventional anti-heart failure treatment. The improvement of cardiac function, LVEDD （left ventricular end-diastolic diameter）, LVESD （left ventricular end-systolic diameter）, LVEF （left ventricular ejection fraction）, IVST （ventricular septum thickness）, LVPWT （left ventricular posterior wall thickness）, LAD （left atrial diameter） and the incidence of adverse events after the treatment within 3 months, 6 months and 1 year were observed in both groups. Results 33 patients in the dapagliflozin group and 37 patients in the conventional anti-heart failure group completed the follow-up. （1）After 3 months, 6 months and 1 year of thefollow-up, the NYNH cardiac function grade of the two groups was improved compared with that before the treatment and the total effective rate of the dapagliflozin group was significantly higher than that of the conventional anti-heart failure group（P < 0.05）.（2）LVEF increased compared with the baseline in both groups, while LVEDD, LVESD, LAD, IVST and LVPWT decreased compared with the baseline（P < 0.05）.（3）After 3 months of treatment , there was no significant difference between LVEF, LVEDD, LVESD, LAD and IVST at 3 months（P > 0.05）and the decrease of LVPWT in dapagliflozin group was significantly higher than that in conventional anti-heart failure group. （4）After 6 months and 1 year of the treatment, the increase of LVEF and the decrease of LAD, IVST and LVPWT in dapagliflozin group were significantly higher than those in conventional anti-heart failure group （P < 0.05）.There was no significant difference in the decrease degree of LVEDD and LVESD between the two groups at 6 months after the treatment（P > 0.05） and the difference was significant at 1 year after the treatment（P < 0.05）. Conclusion On the basis of standardized anti-heart failure drug therapy, the combination of dapagliflozin can further improve the cardiac remodeling and function of patients with heart failure due to mildly reduced ejection fraction. -
表 1 2组患者的临床基线资料比较[n（%）/（$ \bar x \pm s $）/M（P25，P75）]
Table 1. Comparison of baseline clinical data in two group [n（%）/（$ \bar x \pm s $）/M（P25，P75）]
基线指标 达格列净组（n = 33） 常规抗心衰组（n = 37） t/χ2/Z P 年龄（岁） 64.09 ± 11.10 62.46 ± 13.88 0.539 0.592 性别（男/女） 24/9 23/14 0.883 0.348 HF病因 0.005 0.945 缺血性心肌病 19（57.58） 21（56.76） 非缺血性心肌病 合并疾病 14（42.42） 16（43.24） 心房颤动 9（27.27） 11（29.73） 0.052 0.820 高血压 22（66.67） 17（45.95） 3.035 0.081 糖尿病用药情况 19（57.58） 16（43.24） 1.433 0.231 ARB 10（30.30） 9（24.33） 0.315 0.574 ACEI 6（ 18.18） 8（21.62） 0.129 0.719 ARNI 17（51.52） 20（54.05） 0.045 0.832 β受体阻滞剂 比索洛尔 20（60.61） 21（56.76） 0.107 0.744 美托洛尔 13（39.39） 16（43.24） 0.107 0.744 袢利尿剂 22（66.67） 27（72.97） 0.330 0.565 螺内酯 33（ 100.00） 37（ 100.00） − 心功能分级 1.446 0.485 II级 14（42.42） 11（29.73） III级 13（39.40） 16（43.24） IV级 6（ 18.18） 10（27.03） 收缩压（mmHg） 121.67 ± 14.33 115.57 ± 15.42 1.704 0.092 舒张压（mmHg） 75.03 ± 10.16 74.24 ± 11.05 0.309 0.758 心率（次/min） 75.21 ± 10.75 75.14 ± 12.53 0.027 0.978 NT-ProBNP（pg/mL） 2 177.00（446.45 ，3 440.50） 2 086.00（826.50 ，6 711.00） −1.118 0.264 超声心动图结果 LVEF 0.44 ± 0.03 0.44 ± 0.03 −0.326 0.746 LVEDD（cm） 5.62 ± 0.60 5.46 ± 0.55 1.227 0.224 LVESD（m） 4.29 ± 0.56 4.22 ± 0.53 0.516 0.607 LAD（cm） 4.04 ± 0.53 4.22 ± 0.85 −1.041 0.302 IVST（cm） 1.01 ± 0.16 1.06 ± 0.22 −1.143 0.257 LVPWT（cm） 0.98 ± 0.10 1.04 ± 0.15 −1.762 0.083 NT-proBNP：氨基末端脑钠肽前体；HF：心力衰竭；ACEI：血管紧张素转化酶抑制剂；LVEF：左室射血分数；LVEDD：左心室 舒张末期内径；ARB：血管紧张素受体阻滞剂；LVESD：左心室收缩末期内径；LAD：左心房内径；ARNI：血管紧张素受体脑啡肽 酶抑制剂；IVST：室间隔厚度；LVPWT：左室后壁厚度。 
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表 2 2组患者治疗后心功能分级比较[n（%）]
Table 2. Comparison of cardiac functional grading after 3 months of treatment [n（%）]
组别 n 时间 显效 有效 无效 总有效 Z P 达格列净组 33 3 月 2（6.06） 19（57.58） 12（36.36） 21（63.64） 6月 15（45.45） 14（42.42） 4（12.12） 29（87.88） 1 a 22（66.67） 9（27.27） 2（6.06） 31（93.94） 常规抗心衰组 37 3月 1（2.70） 10（27.03） 26（70.27） 11（29.73） 8.081 0.004* 6月 11（29.73） 13（35.14） 13（35.14） 24（64.86） 5.024 0.025* 1 a 16（43.24） 11（29.73） 10（27.03） 27（72.97） 5.398 0.020* Z和P为2组同时期比较的检验统计量的值，*P < 0.05。
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表 3 2组患者治疗后心脏超声结果比较（$ \bar x \pm s $）
Table 3. Comparison of echocardiographic indicatorsin in two groups after treatment（$ \bar x \pm s $）
组别 时间 LVEF（%） LVEDD（cm） LVESD（cm） LAD（cm） IVST（cm） LVPWT（cm） 达格列净组 基线 44.33 ± 3.05 5.62 ± 0.60 4.29 ± 0.56 4.04 ± 0.53 1.01 ± 0.16 0.98 ± 0.10 3月 50.94 ± 5.37* 5.22 ± 0.66* 3.94 ± 0.67* 3.77 ± 0.55* 0.96 ± 0.18* 0.93 ± 0.13*# 6月 54.97 ± 9.30*# 4.97 ± 0.80* 3.66 ± 0.75* 3.45 ± 0.65*# 0.90 ± 0.16*# 0.89 ± 0.12*# 1 a 62.03 ± 9.36*# 4.58 ± 0.75*# 3.38 ± 0.70*# 3.16 ± 0.58*# 0.88 ± 0.18*# 0.87 ± 0.13*# 常规抗心衰组 基线 44.32 ± 2.93 5.46 ± 0.55 4.22 ± 0.53 4.22 ± 0.85 1.06 ± 0.22 1.04 ± 0.15 3月 48.41 ± 7.60* 5.28 ± 0.56* 4.00 ± 0.60* 4.02 ± 0.72* 1.01 ± 0.17* 0.99 ± 0.15* 6月 50.43 ± 7.12* 5.15 ± 0.59* 3.85 ± 0.54* 3.90 ± 0.66* 0.99 ± 0.18* 0.90 ± 0.13* 1 a 51.84 ± 6.81* 4.98 ± 0.68* 3.71 ± 0.55* 3.75 ± 0.66* 0.97 ± 0.16* 0.96 ± 0.02* 同组治疗前后比较，*P < 0.05；与常规抗心衰组治疗后比较，# P < 0.05。
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表 4 2组不良反应发生率比较[n（%）]
Table 4. Comparison of occurrence of adverse effect [n（%）]
组别 n 低血糖 低血压 尿路感染 肾功能损伤 达格列净组 33 0（0.00） 0（0.00） 1（3.03） 0（0.00） 常规抗心衰组 37 3（8.11） 3（8.11） 0（0.00） 5（13.51） χ2 1.168 1.168 − 2.981 P 0.280 0.280 0.471 0.084
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