| BackgroundHeart failure is one of the most common diseases in clinical practice,with multifarious causes.A variety of cardiovascular diseases and noncardiovascular diseases can impair the cardiac function of patients and eventually lead to heart failure.However,refractory heart failure(RHF)is often ineffective to conventional treatment,or even worse,casting a shadow over the patient's health.Patients with refractory heart failure are often admitted to hospital due to repeated illness,which not only brings immeasurable spiritual damage to the patients and their families,but also causes a heavy economic burden to the family and even the whole society.At present,the total number of patients with refractory heart failure in China is still rising,so it is urgent to explore new and effective anti-heart failure drugs that can improve the prognosis of patients.ObjectiveThe clinical efficacy and safety of Sacubitril/valsartan and valsartan in patients with refractory heart failure(RHF)were compared and analyzed,by observing the changes of symptoms and corresponding indicators and the occurrence of adverse reactions before and 3 months after treatment.Methods200 patients with refractory heart failure in cardiovascular medicine department of the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2018 were enrolled.The patients were divided into control group(n=100)and observation group(n=100)according to the difference of treatment methods.The control group was treated with conventional anti-HF drugs and valsartan(Diovan 80mg/qd),while the observation group was treated with conventional anti-HF drugs and Sacubitril/valsartan(Novozymes The initial dose was 50mg/bid,which was increased to 100mg/bid after two weeks as appropriate,until the target oral dose was 200mg/bid).To observe the improvement of symptoms before and 3 months after treatment.The changes of N-terminal B-type natriuretic propeptide(NT-proBNP),high-sensitive troponin T(hs-cTnT),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and 6-minute walking distance(6MWD)before and after treatment in the two groups were compared.To record the occurrence of common adverse reactions such as hypotension,angioedema,hyperkalemia and renal impairment during the treatment in the two groups.ResultsThere was no significant difference in baseline information between the two groups(P>0.05).Before treatment,NT-proBNP,hs-cTnT,LVEDD and LVEF were similar between the two groups(4814.2±484.3?0.42±0.09?56.2±4.1?32.9±5.5 vs 4860.8±535.5?0.40±0.08?55.6±4.3?33.3±5.3,P>0.05).After treatment,the levels of NT-proBNP,hs-cTnT and LVEDD were lower than those before treatment in the same group,and the level of LVEF was higher than that before treatment in the same group,with significantly statistical difference(P<0.05).After treatment,NT-proBNP,hs-cTnT and LVEDD in the observation group were significantly lower than those in the control group,and LVEF was significantly higher than that in the control group,with statistical difference(988.8±535.8 ? 0.20±0.05 ? 51.2±3.2 ? 43.6±5.4 vs 1174.9±408.1?0.29±0.06?52.2±3.4?41.4±4.5,P<0.05).The 6MWD of patients in the observation group was significantly higher than that before treatment in the same group and 3 months after treatment in the control group(332.8±18.1?332.8±18.1 vs 305.0±17.2?312.0±16.0,P<0.05).The 6MWD of patients in the control group was slightly higher than that before treatment,but the difference was not statistically significant(312.0±16.0 vs 308.0±15.5,P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions1.Compared with valsartan,Sacubitril/valsartan is more effective in correcting cardiac function,improving activity tolerance and overall treatment effect in patients with refractory heart failure.2.Compared with valsartan,there was no significant increase in the incidence of drug-related adverse reactions in patients with refractory heart failure treated with Sacubitril/valsartan,which was safe. |
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