| Objective: To evaluate the effectiveness and safety of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction.Methods: Through retrieve domestic and foreign databases: including CNKI、Wanfang database、Pubmed、Clinical Trials、Cochrane library、Embase to get related literatures.The patients in the experimental group were treated with Sacubitril/Valsartan and the control group were treated with ARB/ACEI for heart failure with reduced ejection fraction from 2010 to 2020.The search terms include: heart failure、Sacubitril/Valsartan、Entresto、LCZ696.According to the inclusion criteria and exclusion criteria to screen the literature.Use the bias risk assessment tool version 5.1.0 of the Cochrane Intervention System Evaluation Manual to carry out quality evaluation.Apply Review Manager 5.3to perform statistical analysis on the obtained indicators.Outcome measures included left ventricular ejection fraction(LVEF)、 Left ventricular end-diastolic dimension(LVEDD)、six minutes walk test、terminal pro-B type natriuretic peptide 、 NT-pro BNP 、 The Kansas city cardiomyopathy questionnaire(KCCQ)Ratio of early diastolic mitral flow velocity to early diastolic mitral annular motion velocity(E/e’)、rate of renal function impairment、rate of hyperkalemia、rate of angioedema and rate of symptomatic hypotension.The effectiveness of intervention is evaluated by weighted mean difference(WMD)、relative risk(RR),and interval estimation was conducted in the form of 95% confidence interval(CI).Results: A total of 7 randomized controlled trials(RCTs)with 10689 cases were included,among which 5331 were treated with sacubitril/valsartan and 5385 were treated with ARB/ACEI.To do a meta-analysis that the outcome indicators from the obtained literatures.A total of 5literatures report all-cause mortality outcome.The meta-analysis suggests that sacubitril/valsartan group can reduce all-cause mortality more than ARB/ACEI group[RR = 0.86,95% CI(0.78,0.94),P =0.0006<0.05].A total of3 literatures report the data about LVEF.The meta-analysis suggests that sacubitril/valsartan group can improve left ventricular ejection fraction more than ARB/ACEI group[WMD = 4.61,95% CI(0.57,8.65),P =0.03<0.05].A total of 2 literatures report the data about LVEDD.The meta-analysis suggests that sacubitril/valsartan group can improve LVEDD more than ARB/ACEI group[RR = 0.86,95% CI(0.78,0.94),P =0.0006<0.05].A total of 3 literature reports the data about 6MWT.The meta-analysis suggests that sacubitril/valsartan group can improve 6MWT more than ARB/ACEI group[WMD =29.68,95% CI(1.97,57.38),P =0.04<0.05].A total of 2literatures report the data about NT-pro BNP.The meta-analysis suggests that sacubitril/valsartan group can reduce NT-pro BNP more than ARB/ACEI group[WMD =-245.36,95% CI(-426.09,-74.64),P =0.005].A total of 2literatures report the data about E/e’.The meta-analysis suggests that sacubitril/valsartan group can improve E/e’ more than ARB/ACEI group[RR =0.86,95% CI(0.78,0.94),P =0.0006<0.05].A total of 2 literatures report the data about KCCQ.The meta-analysis suggests that sacubitril/valsartan group can improve KCCQ more than ARB/ACEI group[WMD =3.16,95% CI(0.26,6.06),P <0.03].A total of 4 literatures report the data about prevalence of renal impairment.The meta-analysis suggests that compared with the ARB/ACEI group,there was no significant difference in the prevalence of renal impairment in the sacubitril/valsartan group[RR =0.90,95% CI(0.73,1.10),P =0.31>0.05].A total of 6 literature reports the data about prevalence of hyperkalemia.The meta-analysis suggests that compared with the ARB/ACEI group,there was no significant difference in the prevalence of hyperkalemia in the sacubitril/valsartan group[RR =0.95,95% CI(0.87,1.04),P=0.26>0.05].A total of 4 literatures report the data about prevalence of angioedema.The meta-analysis suggests that compared with the ARB/ACEI group,there was no significant difference in the prevalence of angioedema in the sacubitril/valsartan group[RR =1.36,95% CI(0.74,2.52),P =0.33>0.05].A total of 4 literatures report the data about prevalence ofsymptomatic hypotension.The meta-analysis suggests that compared with the ARB/ACEI group,sacubitril/valsartan group Increase prevalence of symptomatic hypotension[RR = 0.86,95% CI(0.78,0.94),P =0.0006<0.05].Conclusions: For the treatment of heart failure with reduced ejection fraction patient,sacubitril/valsartan is superior in reducing all-cause mortality,improving heart function and improving the quality of life of patients than ARB/ACEI.And it is not inferior in renal function injury rate,hyperkalemia prevalence rate,vascular edema prevalence rate than ARB/ACEI,but may increase the incidence of symptomatic hypotension. |
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