A Clinical Study Of Sacubitril And Valsartan In The Treatment Of Heart Failure With Reduced Ejection Fraction And Pulmonary Hypertension

BackgroundHeart failure is a group of clinical syndromes caused by changes in the structure and / or function of the heart caused by different reasons,leading to a decrease in ejection function.With the aging of the population,patients with heart failure are gradually becoming younger.Mortality will increase significantly if heart failure combined with pulmonary hypertension.As the condition become worsens,combined with right ventricular dysfunction,the mortality will get higher.At present,for patients with pulmonary hypertension due to left heart diseases,the guidelines only recommend treatment against heart failure and primary disease.As a new medicine for the treatment of heart failure,sacubitril valsartan has been widely known by clinicians,but its efficacy in treating pulmonary artery pressure in patients with pulmonary hypertension due to left heart diseases,there are few research involved.Here we studied the efficacy of sacubitril valsartan in patients with heart failure with reduced ejection fraction complicated with pulmonary hypertension,to provide some experience for clinical medication.ObjectiveTo evaluate the effect of sacubitril valsartan on patients with heart failure with reduced ejection fraction complicated with pulmonary hypertension.MethodObserve those patient who had received standard anti-heart failure treatment from June 2017 to June2019 with heart failure with reduced ejection fraction complicated with pulmonary hypertension at Wuhan Puai Hospital.Compare the difference between those patient using sacubitril valsartan and perindopril on NT-proBNP,left ventricular ejection fraction,left ventricular diastolic diameter,pulmonary arterial systolic pressure,right ventricular diastolic diameter,6-minute walk test,rehospitalization rates for heart failure,mortality for evaluate the efficacy between them.Results1.There were no statistical differences in baseline indicators such as age,sex ratio,body mass index,resting heart rate,and mean arterial pressure between the two groups of patients before treatment(P>0.05).2.After 6 months of treatment,the pulmonary artery systolic blood pressure,left ventricular ejection fraction,right ventricular diastolic diameter and NT-proBNP of the two groups had decreased,and the 6-minute walking test and left ventricular ejection fraction had increased,the differences were statistically significant(P<0.05).Among them,the changes of the all indexes above in the sacubitril valsartan group were more significant than those in the perindopril group.3.Among both group,some patient were rehospitalized for heart failure,and the rate of rehospitalization in the sacubitril valsartan group was lower than that in the perindopril group,with a statistical difference(P < 0.05).There was no statistically significant difference in cardiovascular and non-cardiovascular mortality between the two groups(P > 0.05).4.There was no significant difference in the probability of adverse drug reactions and cardiovascular adverse events between the two groups(P>0.05).ConclusionCompared with perindopril,sacubitril valsartan has better efficacy in patients with heart failure with reduced ejection fraction complicated with pulmonary hypertension,has better efficacy in improving cardiac function,reducing pulmonary artery pressure,and reducing rehospitation rate.