Meta-analysis Of The Effect Of Sacubatri Valsartan On Cardiac Remodeling In The Treatment Of Heart Failure Patients With Reduced Ejection Fraction

Objective:To comprehensively analyze the effect of sacubitril valsartan compared with angiotensin converting enzyme inhibitors or angiotensin receptor blockers on cardiac remodeling in the treatment of heart failure patients with reduced ejection fraction by meta-analysis.Methods:The available foreign randomized controlled trial and cohort study on the treatment of cardiac remodeling with sacubatril valsartan was retrived from the establishment of the database to December 2019 by using the computer to search from Pub Med,Embase,and Cochrane Library.Extracting relevant data from the randomized controlled trials and cohort studies which was eligible for inclusion in the study.The Revman5.3 software was used to conduct meta-analysis on the research data extracted from the included literature.Observing the Changes of the five echocardiographic measurement indicators(LVESV,LVEDV,LVESD,LVEDD,LVEF)which can reflect the cardiac remodeling in the experimental group of sacubatril valsartan and the control group of ACEI or ARB on the treatment of HFr EF patients in order to explore the effect of sacubatril valsartan on cardiac remodeling.Results:A total of two RCTs and five cohort studies were included,with a total of 1027 HFr EF patients.The outcome of Meta-analysis shows that,compared with regular heart failure treatment groups of ACEI or ARB,the level of LVESV,LVEDV,LVESD,LVEDD in sacubatril valsartan group after being treated decreaced more than the others,and there was statistically significant difference between the two groups,with the result of LVESV[WMD=﹣20.71,95%CI(﹣36.03,﹣5.38),I~2=0,P=0.008],LVEDV[WMD=﹣22.04,95%CI(﹣24.81,﹣19.26),I~2=0,P<0.00001],LVESD[WMD=﹣3.48,95%CI(﹣5.95,﹣1.01),I~2=0,P=0.006],LVEDD[WMD=﹣2.31,95%CI(﹣3.07,﹣1.56),I~2=0,P<0.00001].The increased level of LVEF in sacubatril valsartan group after being treated is higher than the other group,and the difference between the two groups was statistically significant.At the same time,the study has a large heterogeneity[WMD=﹣4.31,95%CI(﹣6.35,﹣2.27),I2=76%,P<0.0001]which partly caused by different study types resulted from multiple times of sub-group analysis on preconditions of study types,races and visiting time.The sub-group analysis result shows study types is the sources of heterogeneity.The differences of races and length of visiting time are not the sources of heterogeneity.Conclusion:Sacubatril valsartan can not only effectively improve the contractibility of left ventricle but also reverse cardiac remodeling in the treatment of HFr EF patients,and the effect of treatment is superior to ACEI or ARB.However,this meta-analysis has certain limitations,and the results of this study still need to be verified by more domestic and foreign multi-center,large sample,high-quality clinical trials.