Observation Of The Clinical Efficacy Of Sacubitril/Valsartan On Patients With Left Heart-related Cardiac Insufficiency And Pulmonary Hypertension

BackgroundPulmonary hypertension(PH)is very common in patients with left heart failure,which tends to occur in the HFr EF population.For patients with left heart-related cardiac insufficiency and pulmonary hypertension,there is no specific targeted drug therapy,and the treatment of left heart disease is still the main treatment.Sacubitril/Valsartan(LCZ696)is a new type of heart failure treatment drug and the world’s first angiotensin receptor-enkephalinase inhibitor drug,which can effectively reduce the risk of heart failure rehospitalization and death.However,the clinical efficacy of sacubitril/valsartan on left heart-related cardiac insufficiency and pulmonary hypertension is not clear.In this study,by observing the clinical efficacy of sacubitril/valsartan on left heart-related cardiac insufficiency and pulmonary hypertension,it provides a treatment plan and scientific basis for clinicians to treat patients with left heart-related cardiac insufficiency and pulmonary hypertension.ObjectiveTo investigate the clinical efficacy of Sacubitril/Valsartan in patients with left heart related cardiac insufficiency and pulmonary hypertension,and to provide a theoretical basis for clinicians to treat such patients.MethodsSelected left heart-related cardiac insufficiency and pulmonary hypertension patients who were hospitalized in the Department of Cardiology from December 2018 to December2020 and the inclusion criteria as the research subjects,and a total of 80 cases were enrolled.According to different administrations,they were divided into control group,namely enalapril group(n=40)and observation group,namely sacubitril/valsartan group(n=40).Routine anti-heart failure treatment after admission,on this basis,the control group was given enalapril,starting with a small dose of 2.5 mg,twice a day,and the dose was titration gradually to the common maintenance dose(10mg,twice a day)according to the patient’s blood pressure level and the patient’s body tolerance;The observation group was given sacubitril/valsartan,starting with a small dose of 25 mg,twice a day.the dose was adjusted every 2 to 4 weeks according to the patient’s blood pressure level and the patient’s body tolerance,and titrated gradually to the target recommended dose(200mg,twice a day).After continuous observation for 6 months,the changes in World Health Organization pulmonary hypertension function classification(WHO-FC classification),6-minute walk test(6-MWD),plasma N-terminal pro-B-type natriuretic peptide(NT-Pro BNP),and ultrasound images(left ventricular end diastolic diameter(LVEDD),right ventricular end diastolic diameter(RVEDD),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),tricuspid regurgitation rate(TRV))were compared between the two groups.Results1.There were no significant differences in baseline data and pre-treatment indicators of between the enalapril group and the sacubitril/valsartan group(P>0.05).2.In terms of improvement in the WHO-FC classification,the improvement of WHO-FC classification of sacubitril/valsartan group was better than that of enalapril group,and the difference was statistically significant(P<0.05).the sacubitril/valsartan group was significantly improved after treatment compared with before treatment(P<0.05),while the enalapril group had no significant difference before and after treatment(P>0.05).3.After treatment,the PASP and TRV values of the two groups were decreased,and the difference of the above indicators in the sacubitril/valsartan group were higher than those in the control group,the difference was statistically significant(P<0.05).It indicated that sacubitril/valsartan reduced pulmonary artery pressure while concomitantly decreasing tricuspid regurgitation rate,and was superior to enalapril group.4.After treatment,the LVEDD,RVEDD values of the two groups were decreased,and the LVEF was increased,and the difference of the above indicators in the sacubitril/valsartan group were higher than those in the control group,the difference was statistically significant(P<0.05).It shows that sacubitril/valsartan can improve the ventricular remodeling function of left heart-related cardiac insufficiency and pulmonary hypertension patients better than enalapril.5.After treatment,the 6-MWD increased and the NT-pro BNP decreased in both groups compared with before,and the difference were significantly higher in the sacubitril/valsartan group than in the enalapril group,the difference was statistically significant(P<0.05).It indicated that sacubitril/valsartan can effectively improve the exercise tolerance of patients with left heart-related cardiac insufficiency and pulmonary hypertension,and the clinical efficacy is better than that of enalapril.6.After treatment,the probability of adverse drug reactions and cardiovascular adverse events in the two groups was not statistically significant(P>0.05).ConclusionSacubitril/valsartan can effectively reduce the pulmonary artery systolic blood pressure,improve clinical symptoms,remodel the ventricle,and improve the long-term prognosis in patients with left heart-related cardiac insufficiency and pulmonary hypertension,and it is relatively safe.