| ObjectiveThe purpose of this study was to observe the clinical effect of sacubitril-valsartan on the left ventricular end-diastolic diameter(LVEDd),left atrial diameter(LAD),N-terminal of the prohormone brain natriuretic peptide(NT-pro BNP)and the influence of short-term prognosis including heart failure rehospitalization and sinus rhythm maintenance rate after radiofrequency ablation in patients with persistent atrial fibrillation and heart failure with preserved ejection fraction.In order to provide clinical evidence for the treatment of patients with AF-HFp EF after radiofrequency ablation.MethodsA total of 80 patients with AF-HFp EF after radiofrequency ablation who were admitted to the Department of Cardiology,Affiliated Hospital of Qingdao University from January2020 to June 2021 were selected and randomly divided into the experimental group and the control group,40 cases in each.Both groups of patients received basic heart failure drugs,and the treatment strategy was adjusted in time according to the patient’s condition,and an individualized treatment plan was formulated.The control group was given valsartan(Novartis Pharmaceuticals Ltd.),the starting dose was 80 mg,once a day,the drug dose was adjusted according to the patient’s blood pressure,and gradually reached the maximum target dose,80 mg,twice a day.The experimental group was given sacubitril-valsartan(Novartis Pharmaceuticals Ltd.)on the basis of conventional treatment,starting at a dose of 25 mg to 50 mg,twice a day.According to the patient’s condition and blood pressure tolerance,the dose is doubled every 2 to 4 weeks until the maximum target is reached.Maintenance dose is 200 mg,twice a day.After following up for 3 and 6 months,we compared the changes of LVEDd,LAD and NT-pro BNP in the two groups,and recorded the sinus rhythm maintenance rate and adverse reactions in the two groups.Atrial arrhythmia or heart failure rehospitalization was the end point.Kaplan-Meier survival curve method was used to compare the 6-month survival rate without end point between the two groups,and log Rank was used to test whether there was statistical significance between the two groups.SPSS25.0 was used for statistical analysis of follow-up data,and P<0.05 was considered statistically significant.ResultsThe average age of the patients in the experimental group was(65.80±7.81)years old,of which 24 were female(60.00%);the average age of the patients in the control group was(63.68±9.13)years old,of which 21(52.50%)were female.There were no adverse reactions such as severe hypotension and the study was terminated within 6 months of follow-up in both groups.As of the end of the follow-up,22.5%of the patients in the experimental group finally received sacubitril-valsartan 50 mg twice a day,70%of the patients took 100 mg twice a day,7.5%of the patients took 200 mg,twice a day;92.5%of the patients in the control group took valsartan 80 mg,once a day,and 7.5%of the patients took valsartan 80 mg,twice a day.1.Baseline data of the two groups:The baseline data(including age,gender,BMI,underlying diseases,laboratory indicators,cardiac function indicators,drug use,etc.)parameters before taking the medicine in the two groups were compared,and the difference was not statistically significant(P>0.05).2.The LAD,LVEDd,NT-pro BNP of the experimental group were decreased after 3months of treatment with sacubitril-valsartan,and the difference was statistically significant(P<0.05);the control group was treated with valsartan after 3 months,LAD and NT-pro BNP were decreased compared with those before treatment,and the difference was statistically significant(P<0.05).After 6 months of treatment,LAD,LVEDd,and NT-pro BNP in the experimental group and the control group were all decreased compared with those before treatment,and the difference between the two groups was statistically significant(P<0.05).3.After 3 months of treatment,the LVEDd and NT-pro BNP in the experimental group were improved compared with those in the control group,and the difference was statistically significant(P<0.05),but there was no significant difference in LAD between the two groups(P>0.05).6 months after treatment,LAD,LVEDd,and NT-pro BNP in the experimental group were significantly improved compared with those in the control group,and the differences were statistically significant(P<0.05).4.3 months after treatment,the patients in the experimental group who maintained sinus rhythm were higher than those in the control group[(36,90.00%)vs(32,80.00%)],and the patients in the experimental group who were hospitalized for heart failure were less than those in the control group[(1,2.50%)vs(3,7.50%)],there was no significant difference in sinus rhythm maintenance rate and heart failure rehospitalization between the two groups(P>0.05);the patients in the experimental group who maintained sinus rhythm 6 months after treatment higher than that in the control group[(35,87.50%)vs(27,67.50%)],and the patients in the experimental group were less than those in the control group[(1,2.50%)vs(6,15.00%)].There were statistically significant differences in sexual rhythm maintenance rate and heart failure rehospitalization(P<0.05).Kaplan-Meier analysis showed that the 6-month heart failure rehospitalization-free survival rate between the two groups was significantly different(Log Rank test:χ~2=3.859,P=0.049).The 6-month atrial arrhythmia event-free survival rate between the two groups,the difference was not statistically significant(Log Rank test:χ~2=1.808,P=0.179).ConclusionCompared with radiofrequency ablation alone,the addition of sacubitril-valsartan to patients with AF-HFp EF after radiofrequency ablation can improve cardiac function,reverse myocardial remodeling,improve sinus rhythm maintenance,and prevent recurrence of atrial fibrillation,so as to further improve the clinical efficacy and reduce the occurrence of poor prognosis. |
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