Effect of dagliflozin combined with levosimendan on sST2， Ang⁃Ⅱ and cardiac function in elderly patients with post⁃PCI heart failure
Received date: 2024-10-22
Online published: 2025-02-19
目的 观察达格列净结合左西孟旦对经皮冠状动脉介入术（PCI）后心力衰竭老年患者可溶性生长刺激表达基因2蛋白（sST2）、血管紧张素Ⅱ（Ang-Ⅱ）及心功能的影响。 方法 选取2021年1月至2023年10月江南大学附属医院心内科收治的急性心肌梗死（AMI）患者80例，患者均接受PCI治疗且治疗后存在心力衰竭，采用抽签法分为两组。两组均采用常规对症治疗，常规组加用左西孟旦治疗，结合组加用达格列净结合左西孟旦治疗。比较两组心功能指标、sST2、氨基末端脑利钠肽前体（NT-pro BNP）、肾素-血管紧张素-醛固酮系统指标、心肌肌球蛋白结合蛋白-C（cMyBP-C）、心肌肌钙蛋白l（cTnI）、肌红蛋白（MyO）、6分钟步行距离、心衰计分系统（Lee）评分、西雅图心绞痛量表（SAQ）评分差异，统计两组随访6个月累计主要不良心血管事件（MACE）发生率。 结果 常规组与结合组治疗前心功能指标、sST2、NT-proBNP、cMyBP-C、cTnI、MyO、肾素-血管紧张素-醛固酮系统指标比较，差异无统计学意义（P > 0.05）。常规组与结合组治疗后左心室射血分数（LVEF）高于治疗前，肾素-血管紧张素-醛固酮系统指标、收缩末期左室内径（LVEDD）、sST2、NT-proBNP、舒张末期左室内径（LVESD）、cMyBP-C、cTnI、MyO、左室质量指数（LVMI）低于治疗前（P < 0.05）。结合组治疗后LVEF高于常规组，肾素-血管紧张素-醛固酮系统指标、sST2、cMyBP-C、LVEDD、NT-proBNP、LVESD、cTnI、MyO、LVMI低于常规组（P < 0.05）。常规组与结合组治疗前6分钟步行距离、Lee评分、SAQ评分比较，差异无统计学意义（P > 0.05）。常规组与结合组治疗后6分钟步行距离、SAQ评分高于治疗前，Lee评分低于治疗前（P < 0.05）。结合组治疗后6分钟步行距离、SAQ评分高于常规组，Lee评分低于常规组（P < 0.05）。结合组随访6个月累计MACE发生率低于常规组，差异有统计学意义（P < 0.05）。常规组发生胃肠道反应2例，结合组发生低血压1例，胃肠道反应3例。 结论 达格列净结合左西孟旦可改善PCI后心力衰竭患者心功能，调节肾素-血管紧张素-醛固酮系统，提高运动耐力与生活质量。
王广艳 , 苏衡 , 朱君 . 达格列净结合左西孟旦对经皮冠状动脉介入术后心力衰竭老年患者sST2、Ang-Ⅱ及心功能的影响[J]. 实用医学杂志, 2025 , 41(3) : 396 -402 . DOI: 10.3969/j.issn.1006-5725.2025.03.014
Objective To observe the effects of dagliflozin combined with levosimendan on soluble growth-stimulated expressed gene 2 protein （sST2）， angiopoietin Ⅱ （Ang-Ⅱ） and cardiac function in elderly patients with heart failure after percutaneous coronary intervention （PCI）. Methods Eighty patients with acute myocardial infarction （AMI） admitted to the Department of Cardiology of the Affiliated Hospital of Jiangnan University from January 2021 to October 2023 were selected and divided into two groups using the lottery method. Both groups were treated with conventional therapy. The conventional group was treated with levosimendan， and the combination group with dagliflozin combined with levosimendan. Cardiac function indexes， sST2， amino-terminal brain natriuretic peptide precursor （NT-pro BNP）， renin-angiotensin-aldosterone system indexes， cardiac myosin-binding protein-C （cMyBP-C）， cardiac troponin I （cTnI）， myoglobin （MyO）， 6-minute walking distance， heart failure scoring system （Lee） score， and the Seattle Angina Scale （SAQ） score were compared between the two groups. The cumulative major adverse cardiovascular event （MACE） rate at 6-month follow-up was counted in both groups. Results The comparison of cardiac function indexes， sST2， NT-proBNP， cMyBP-C， cTnI， MyO， and renin-angiotensin-aldosterone system indexes before treatment between the two groups showed no statistical significance （P > 0.05）. Left ventricular ejection fraction （LVEF） of the two groups was higher than that before treatment， and the indexes of the renin-angiotensin-aldosterone system， end-systolic left intraventricular diameter （LVEDD）， sST2， NT-proBNP， end-diastolic left intraventricular diameter （LVESD）， cMyBP-C， cTnI， MyO， and left ventricular mass index （LVMI） were lower （P< 0.05）. LVEF was higher in the combination group than that in the conventional group after treatment， and the indexes of the renin-angiotensin-aldosterone system， sST2， cMyBP-C， LVEDD， NT-proBNP， LVESD， cTnI， MyO， and LVMI were lower than those in the conventional group （P < 0.05）. There was no statistically significant difference between the two groups in terms of 6-minute walking distance， Lee score， and SAQ score before treatment （P > 0.05）. The 6-minute walking distance and SAQ score after treatment in both groups were longer and higher than those before treatment， and the Lee score was lower （P < 0.05）. The 6-minute walking distance and SAQ score after treatment in the combination group were longer and higher， and Lee score was lower than those in the conventional group （P < 0.05）. The cumulative incidence of MACE at 6-month follow-up in the combination group was lower than that in the conventional group， and the difference was statistically significant （P < 0.05）. Two cases of gastrointestinal reactions were found in the conventional group， and one case of hypotension and three cases of gastrointestinal reactions in the combination group. Conclusion Dagliflozin combined with levosimendan improves cardiac function， modulates the renin-angiotensin-aldosterone system， and improves exercise tolerance and quality of life in patients with heart failure after PCI.
| 1 | OZAKI Y， HARA H， ONUMA Y， et al. CVIT expert consensus document on primary percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） update 2022［J］. Cardiovasc Interv Ther， 2022，37（1）：1-34. doi:10.1007/s12928-021-00829-9 |
| 2 | SCH?FER A， K?NIG T， BAUERSACHS J， et al. Novel Therapeutic Strategies to Reduce Reperfusion Injury After Acute Myocardial Infarction［J］. Curr Probl Cardiol， 2022，47（12）：e101398. doi:10.1016/j.cpcardiol.2022.101398 |
| 3 | BISCAGLIA S， GUIDUCCI V， ESCANED J， et al. Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.［J］ N Engl J Med， 2023，389（10）：889-898. doi:10.1056/nejmoa2300468 |
| 4 | HOSOKAWA Y， YAMAMOTO T， TARA S， et al. Comparison of Percutaneous Coronary Intervention Procedures and Outcomes for Recent and Acute ST-Elevation Myocardial Infarction［J］. Int Heart， 2023，64（3）：352-357. doi:10.1536/ihj.22-656 |
| 5 | MODZELEWSKI K L， PIPILAS A， BOSCH N A. Comparative Outcomes of Empagliflozin to Dapagliflozin in Patients With Heart Failure［J］. JAMA Netw Open， 2024，7（5）：e249305. doi:10.1001/jamanetworkopen.2024.9305 |
| 6 | SAITO Y， OYAMA K， TSUJITA K， et al. Treatment strategies of acute myocardial infarction： Updates on revascularization， pharmacological therapy， and beyond［J］. J Cardiol， 2023，81（2）：168-178. doi:10.1016/j.jjcc.2022.07.003 |
| 7 | ALI A E， MAZROUA M S， ELSABAN M， et al. Effect of Dapagliflozin in Patients with Heart Failure： A Systematic Review and Meta-Analysis［J］. Glob Heart， 2023，18（1）：45-46. doi:10.5334/gh.1258 |
| 8 | 中华医学会心血管病学分会，中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南（2019）［J］.中华心血管病杂志， 2019， 47（10）：766-783. doi:10.3760/cma.j.issn.0253-3758.2019.10.003 |
| 9 | 田朝伟，陈晓辉.急性心力衰竭的诊治进展：2016 ESC 急慢性心力衰竭诊断和治疗指南［J］.中华急诊医学杂志， 2016， 25（7）：4. |
| 10 | WELKER C C， MIELKE JAR， RAMAKRISHNA H. Levosimendan and Low Cardiac Output After Cardiac Surgery： Analysis of Trial Data［J］. J Cardiothorac Vasc Anesth， 2023，37（7）：1294-1297. doi:10.1053/j.jvca.2023.03.011 |
| 11 | COX Z L， COLLINS S P， HERNANDEZ G A， et al. Efficacy and Safety of Dapagliflozin in Patients With Acute Heart Failure［J］. J Am Coll Cardiol， 2024，83（14）：1295-1306. doi:10.1016/j.jacc.2024.02.009 |
| 12 | LEE S H， JEONG M H， AHN J H， et al. Predictors of recurrent acute myocardial infarction despite successful percutaneous coronary intervention［J］. Korean J Intern Med， 2022，37（4）：777-785. doi:10.3904/kjim.2021.427 |
| 13 | ZHOU Y， TAI S， ZHANG N， et al. Dapagliflozin prevents oxidative stress-induced endothelial dysfunction via sirtuin 1 activation［J］. Biomed Pharmacother， 2023，165（1）：e115213. doi:10.1016/j.biopha.2023.115213 |
| 14 | CHARAYA K V， SCHEKOCHIKHIN D Y， NIKIFOROVA T V， et al. The use of Dapagliflozin in Acute Decompensated Heart Failure： Results of the Randomized Study［J］. Kardiologiia， 2023，63（8）：11-18. doi:10.18087/cardio.2023.8.n2221 |
| 15 | VON LEWINSKI D， KOLESNIK E， AZIZ F， et al. Timing of SGLT2i initiation after acute myocardial infarction［J］. Cardiovasc Diabetol， 2023，22（1）：269-271. doi:10.1186/s12933-023-02000-5 |
| 16 | TANASHAT M， MANASRAH A， ABOUZID M. Effects of dapagliflozin and empagliflozin on 6-min walk distance in heart failure with preserved and reduced ejection fraction： A systematic review and meta-analysis of randomized controlled trials involving 2624 patients［J］. Eur J Clin Pharmacol， 2024，80（7）：951-963. doi:10.1007/s00228-024-03660-2 |
| 17 | BUTT J H， DOCHERTY K F， KOSIBOROD M N， et al. Dapagliflozin and Physical and Social Activity Limitations in Heart Failure With Reduced Ejection Fraction［J］. JACC Heart Fail，2023，11（10）：1411-1423. doi:10.1016/j.jchf.2023.04.016 |
| 18 | 陈雨意，田鹏超，冯佳禹，等. 即时检验（POCT）检测的sST2相关影响因素及其对心力衰竭的预后价值［J］. 中国循环杂志，2022，37（6）：595-601. |
| 19 | 刘侃玲，张瑶. 达格列净对老年急性心肌梗死后心力衰竭患者心功能及MACE的影响［J］. 解放军医学杂志， 2023， 48（12）：1427-1432. |
| 20 | LEWIS G D， GOSCH K， COHEN L P， et al. Effect of Dapagliflozin on 6-Minute Walk Distance in Heart Failure With Preserved Ejection Fraction： PRESERVED-HF［J］. Circ Heart Fail，2023，16（11）：e010633. doi:10.1161/circheartfailure.123.010633 |
| 21 | 盛雪，纪征，王兆翔，等. 达格列净联合诺欣妥对急性心肌梗死患者急诊介入治疗后心力衰竭的疗效［J］. 实用医学杂志，2022，38（11）：1410-1414. doi:10.3969/j.issn.1006?5725.2022.11.020 |
| 22 | CHATUR S， VADUGANATHAN M， CLAGGETT B， et al. Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction： The DELIVER trial［J］. Eur Heart J， 2023，44（31）：2930-2943. doi:10.1093/eurheartj/ehad283 |
| 23 | 黎德恩，梅啸，李明琰. 急性ST段抬高型心肌梗死患者直接经皮冠脉介入治疗术后住院期间发生心力衰竭的危险因素［J］. 实用医学杂志，2021，37（13）：1674-1677，1683. doi:10.3969/j.issn.1006 |
| 24 | OTSUKA Y， ISHII M， IKEBE S， et al. BNP level predicts bleeding event in patients with heart failure after percutaneous coronary intervention［J］. Open Heart，2023，10（2）：e002489. doi:10.1136/openhrt-2023-002489 |
| 25 | HU J， XU J， TAN X， et al. Dapagliflozin protects against dilated cardiomyopathy progression by targeting NLRP3 inflammasome activation［J］. Naunyn Schmiedebergs Arch Pharmacol，2023， 396（7）：1461-1470. |
/
| 〈 |
|
〉 |