| ObjectiveTo evaluate the clinical effect,prognosis and safety of sacubitril-valsartan in treating patients with chronic heart failure.MethodsA total of 78 patients with chronic heart failure that were accepted from January 2019 to December 2020 to the Department of Cardiology of the First Affiliated Hospital of Anhui Medical University were picked and seperated by ejection fraction into the HFr EF group and HFp EF group.Among them,there were 40 patients in the HFr EF group and 38 patients in the HFp EF group.All patients were treated with ARNI on the foundation of classical heart failure treatment.Biological indicators including brain natriuretic peptide(BNP),cardiac ultrasound indicators such as left ventricular ejection fraction(LVEF)along with left atrial diameter(LAD)along with left ventricular enddiastolic diameter(LVEDD),and safety indicators such as serum potassium and renal function)of both groups were all carefully compared after 6 months treatment.Treatment safety were also assessed.The end point event was defined as cardiovascular death or hospitalization for worsening heart failure.The accumulated end-point event free survival rate in 6 months of two HF groups were calculated and compared by Kaplan-Meier survival curve method.Results1、Changes of BNP levels before and after treatment(1)The BNP level in HFr EF group [165.9(56.9,545.5)pg/ml] after 6 months treatment with sacubitril-valsartan was lower than that before treatment [1327.9(905.7,2921.6)pg/ml],The difference was statistically significant(P < 0.05).(2)In the HFp EF group,the BNP level [175.2(80.0,393.2)pg/ml] after 6 months treatment with sacubitril-valsartan was lower than that before treatment [833.7(607.5,1117.0)pg/ml].The difference was statistically significant(P < 0.05).2、Changes of LAD,LVEDD and LVEF before and after treatment(1)In the HFr EF group,LVEF[39.0(35.0,44.5)%] after 6 months treatment with sacubitril-valsartan was increased than that before treatment 35.0(30.0,38.5)%,LAD [4.4(4.0,4.9)cm] after 6 months treatment with sacubitril-valsartan was decreased than that before treatment LAD[4.6(4.2,5.2)cm].LVEDD(6.34±0.80cm)after 6 months treatment with sacubitril-valsartan was decreased than that before treatment LVEDD(6.53±0.70cm).The differences were all sta-tistically significant(P < 0.05).(2)In the HFp EF group,LVEF [58.0(56.5,59.0)%] after 6 months treatment with sacubitril-valsartan was slightly increased than that before treatment LVEF[55.5(53.0,59.0)%](P =0.05);LVEDD(5.28±0.78cm)after 6 months treatment with sacubitril-valsartan was decreased than that before treatment LVEDD(5.39 ± 0.84 cm).The difference was statistically significant(P < 0.05).3、Cumulative endpoint-free survival at 6 months after sacubitril-valsartan treatment After 6 months treatment,the cumulative endpoint-free survival rate was 81.9% in the HFr EF group and 85.0% in the HFp EF group,both of which achieved good clinical benefit.There was no significant difference in the cumulative endpoint-free survival rate between the two groups(P=0.694).4、Safety evaluation after sacubitril-valsartan treatment(1)In the HFr EF group,Scr[83.2(69.1,99.6)umol/L] after 6 months treatment with sacubitril-valsartan was not statistically changed than Scr[84.2(74.3,96.9)umol/L] before treatment(P>0.05),e GFR[75.0(60.0,104.0)ml/(min·1.73m~2)] after 6 months treatment with sacubitril-valsartan was not statistically changed than e GFR[84.5(65.3,97.5)ml/(min·1.73m~2)] before treatment(P>0.05).Plasma potassium level(4.3±0.8mmol/L)after 6 months treatment with sacubitrilvalsartan was not statistic-ally changed than plasma potassium level(4.0±0.5mmol/L)before treatment(P > 0.05).No serious hypotension,angioedema and other adverse reactions were observed.(2)In the HFp EF group,Scr[82.2(58.8,95.7)umol/L] after 6 months treatment with sacubitril-valsartan was not statistically changed than Scr[67.3(56.1,88.1)umol/L] before treatment(P>0.05),e GFR[75.0(61.0,96.0)ml/(min·1.73m~2)] after 6 months treatment with sacubitril-valsartan was not statistically changed than e GFR[84.0(75.0,99.0)ml/(min·1.73m2] before treatment(P>0.05).Plasma potassium level(4.1±0.5mmol/L)after 6 months treatment with sacubitrilvalsartan was not statistic-ally changed than plasma potassium level(3.9±0.5mmol/L)before treatment(P > 0.05).No serious hypotension,angioedema and other adverse reactions were observed.Conclusion1、In clinical practice,the LAD and LVEDD of patients in the HFr EF group were reduced and LVEF was increased after sacubitril-valsartan treatment,while LVEDD was decreased and LVEF was slightly increased after treatment in the HFp EF group,and BNP was significantly reduced in the two groups,and no serious adverse events such as renal function deterioration and hypotension occurred.It is suggested that sacubitril-valsartan can improve ventricular remodeling in patients with HFr EF and HFp EF,and has good safety.2、Cumulative endpoint-free survival rate were high at 6 months in patients with HFr EF and HFp EF treated with sacubitril-valsartan,and there was no significant difference between the two groups,suggesting that sacubitril-valsartan can improve the cardiovascular prognosis of HFr EF and HFp EF patients.3、Low dose initiation reduces the risk of hypotension and deterioration of renal function,and increases patient tolerance and compliance with ARNI. |
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