| Background and objectiveAt present,heart failure and atrial fibrillation are two major problems troubling clinicians in the treatment of cardiovascular diseases.Rapid atrial arrhythmia,long-term hypertension,long-term myocardial ischemia of coronary heart disease can not be corrected and improved,cardiomyopathy and rheumatic valvular heart disease can cause myocardial structural remodeling and myocardial electrical remodeling,cardiomyocyte hypertrophy,cardiac structural changes,followed by cardiac dysfunction,leading to the occurrence of heart failure,but also greatly increase the incidence of atrial fibrillation.The American Framham Heart study report shows that the annual incidence of atrial fibrillation in patients with heart failure is 54%,and a large number of patients with heart failure complicated with atrial fibrillation can also be found in clinical work.When patients with heart failure complicated with atrial fibrillation,the progress of heart failure is faster,the quality of life and prognosis are worse,and the incidence of disability and death is higher.To explore the treatment of heart failure with atrial fibrillation,reduce the number of episodes of atrial fibrillation,improve cardiac function and heart failure symptoms,improve the quality of life of patients,improve the prognosis of patients is our goal.Studies have shown that angiotensin receptor antagonists can reverse myocardial hypertrophy,improve the long-term prognosis of heart failure and prevent atrial fibrillation electrical remodeling,and natriuretic peptide can inhibit the activation of renin-angiotensin system and sympathetic nervous system.It can also reverse myocardial hypertrophy and improve the long-term prognosis of heart failure.The first clinical angiotensin receptor-enkephalin inhibitor-Sacubitril/valsartan.contains angiotensin receptor antagonist and can reduce the degradation of natriuretic peptide.in theory,it can more effectively inhibit myocardial hypertrophy and myocardial fibrosis,prevent atrial fibrillation electrical remodeling and atrial remodeling,so as to improve left ventricular function and heart failure symptoms in patients with heart failure and atrial fibrillation.However,the above views are not supported by clinical data.This experiment was carried out to explore the effect of Sacubitril/valsartan.on heart failure complicated with atrial fibrillation.In order to facilitate experimental observation,combined with the clinical practice of our hospital,patients with heart failure complicated with paroxysmal atrial fibrillation were selected as subjects.MethodsPatients with heart failure complicated with paroxysmal atrial fibrillation hospitalized in the Department of Cardiology of Henan University Huaihe Hospital from February 2020 to June 2021 were randomly divided into treatment group and control group.The treatment group was given Sacubitril/valsartan.and the control group was given valsartan.At the same time,both groups were routinely treated with metoprolol succinate,aldosterone receptor blockers and diuretics.The risk of embolism and bleeding was evaluated according to CHA2DS2-VASc score and HAS-BLED score.Patients with high risk of embolism were treated with oral rivasaban anticoagulation.The patients in the treatment group and the control group were followed up for half a year after discharge.the number of episodes of atrial fibrillation in the treatment group and the control group was lower than that in the first half of the trial,and the times of re-hospitalization due to atrial fibrillation were compared between the treatment group and the control group.Left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular early diastolic maximum blood flow(peak E),mitral atrial systolic maximum flow(peak A),superior and inferior diameter of left atrium,left and right diameter of left atrium and anterior and posterior diameter of left atrium were evaluated by color Doppler ultrasound.The E / A value was calculated according to E peak and A peak,left atrial volume index = π / 6 * atrial superior and inferior diameter * atrial left and right diameter * atrial anterior and posterior diameter / body surface area,reflecting the changes of left atrial structure before and after volume index.the changes of cardiac function of N-terminal brain natriuretic peptide precursor,the improvement of 6-minute walking test;the occurrence of adverse cardiovascular events and the incidence of drug side effects were observed.Results1.The frequency of atrial fibrillation and the times of re-hospitalization due to atrial fibrillation heart failure in the treatment group and the control group were significantly lower than those in the control group(P < 0.05).The frequency of atrial fibrillation and the number of re-hospitalization due to atrial fibrillation heart failure in the treatment group were significantly lower than those in the control group(P < 0.05).2.There was no significant difference in baseline ejection fraction,left ventricular end-diastolic diameter,left atrial volume index and E / A ratio between the treatment group and the control group(P >0.05).Compared with the control group,the ejection fraction and E / A ratio in the treatment group were higher than those in the control group,while the left ventricular end-diastolic diameter and left atrial volume index decreased significantly in the treatment group(P < 0.05).3.There was no significant difference in baseline NT-pro BNP level between the treatment group and the control group.(P > 0.05)3 months and half a year later,the level of NT-pro BNP in the treatment group was significantly lower than that in the control group(P < 0.05).4.There was no significant difference in baseline cardiac function grade and 6-minute walking test between the treatment group and the control group(P > 0.05),but half a year later,the cardiac function and6-minute walking test were improved in the two groups,and the improvement in the treatment group was more obvious than that in the control group.the difference was statistically significant(P < 0.05).5.After half a year treatment,there was no significant difference in the incidence of cardiovascular death,cerebral embolism,severe arrhythmia and other cardiovascular adverse events between the treatment group and the control group(P > 0.05).There was no significant difference in the incidence of side effects such as renal function injury,dry cough,symptomatic hypotension and hyperkalemia(P > 0.05).ConclusionSacubitril/valsartan.can reduce the frequency of atrial fibrillation in patients with heart failure complicated with paroxysmal atrial fibrillation,reduce the number of rehospitalization due to atrial fibrillation and heart failure,improve left ventricular function and reduce left atrial volume index.It does not increase the incidence of cardiovascular adverse events and adverse drug reactions,and the safety is good. |
PDF Full Text Request