| Background and objective: According to the difference of ejection fraction,heart failure can be divided into three types: heart failure with reduced ejection fraction(HFr EF),heart failure with mid-range fraction(HFmr EF)and heart failure with preserved ejection fraction(HFpEF).Among them,more than half of the heart failure patients are of the ejection fraction preserved type,which has a high morbidity and mortality rate.Currently,the pathogenesis of HFpEF is not very clear.A large number of studies have shown that inflammatory response and microvascular dysfunction induced by various factors may be one of the important pathophysiological mechanisms of HFpEF.Due to the diversity of HFpEF phenotypes,no significant and effective treatment has been obtained.Sacubitril/valsartan,an angiotensin receptor neprilysin inhibitor(ANRI),is effective in improving symptoms and reducing hospitalization and mortality in patients with HFr EF.Sacubitril/valsartan can also reduce cardiac inflammation in diabetic cardiomyopathy.It is worth exploring whether sacubitril/valsartan can improve cardiac function in patients with HFpEF through mechanisms that reduce the inflammatory response.This study discusses the effects of sacubitril/valsartan on cardiac function and inflammatory factors in patients with HFpEF to provide a basis for the clinical use of sacubitril/valsartan in the treatment of HFpEF.Research objects and methods: 62 patients diagnosed with HFpEF in the Affiliated Hospital of Jiujiang College between August 2022 and January 2023 were selected.1)According to NYHA class,patients were divided into low NYHA class group(NYHA class I ～ II)(n=14)and high NYHA class group(NYHA class III ～VI)(n=48),and a binary logistic regression model to analyze the correlation between cardiac function indexes(NT-proBNP),inflammatory indexes(CRP,NLR,MLR)and NYHA class;ROC curve was used to assess the accuracy of the above indexes in predicting NYHA class in patients with HFpEF.2)According to whether to take sacubitril/valsartan or not,the study subjects were divided into control group(n=31)and research group(n=31).Patients in both groups were treated with diuretics,β-blockers and other conventional treatments,the control group was treated with ACEI/ARB drugs on the basis of conventional treatment,and the research group was treated with sacubitril/valsartan on the basis of conventional treatment,comparing the changes of NT-proBNP,CRP,NLR and MLR before and after treatment in both groups,and exploring the effects of sacubitril/valsartan on cardiac function and inflammatory in patients with HFpEF.Results: 1)The differences in NT-proBNP,CRP,NLR and MLR between the two groups before treatment were not statistically significant(P>0.05).2)The differences between NT-proBNP(β=0.001,OR=1.001),CRP(β=0.229,OR=1.258),NLR(β=0.844,OR=2.325)and NYHA class were positively correlated,and the difference was statistically significant(P<0.05),MLR was not significantly correlated with NYHA classification,and the difference was not statistically significant(P>0.05).The accuracy of NT-proBNP,CRP,and NLR in predicting NYHA class was 90.6%,75.4%,and 77.1%.3)In both the control and research groups,NT-proBNP,CRP,NLR and MLR improved after 1 week of treatment,and the decrease in NT-proBNP and NLR in the research group was more significant than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant change in e GFR in the two groups after treatment(P>0.05).Conclusion: 1)NT-proBNP,CRP,and NLR were positively correlated with HF class in patients with HFpEF.2)Sacubitril/valsartan could effectively improve NT-proBNP and reduce inflammatory reaction in patients with HFpEF,and did not significantly aggravate renal function. |
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