Assessment Of Efficacy About Angiotensin Receptor-neprilysin Inhibitors On Ventricular Remodeling And Improvement Of Cardiac Function In Patients Concerning Chronic Heart Failure With Reduced Ejection Fraction

Background and Objective: Heart failure(HF)is currently the most common cause of death in cardiovascular disease,and its morbidity and mortality are still increasing every year.The new drug angiotensin receptor-neprilysin inhibitors(ARNI)can significantly improve symptoms and improve quality of life in patients with heart failure with reduced ejection fraction.To study the differences between ARNI,angiotensin converting enzyme inhibitors(ACEI)and angiotensin receptor blockers(ARB)in inhibiting ventricular remodeling,improving clinical symptoms and improving quality of life in patients about chronic heart failure with reduced ejection fraction(HFrEF).Methods: Selected 150 relevant patients treated in our hospital from May 2018 to March 2019.They were randomly divided into ARNI,ACEI,and ARB groups.At the same time,soluble growth stimulation expressed gene 2 protein(sST2),N-terminal pro-brain natriuretic peptide(NT-proBNP),6-minute walk test(6MWT),Kansas city cardiomyopathy questionnaire(KCCQ),left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVEDD),left ventricular mass index(LVMI),and electrocardiogram were measured in three groups of patients.After that,on the basis of conventional treatment,they were given three types of drugs: ARNI,ACEI,and ARB.They were followed up for 1 year,and the drug dose was gradually increased to the maximum tolerated dose.During the period,they recorded the changes of related indicators,the occurrence of adverse reactions,readmissions,and cardiac death.Multivariate analysis of variance,non-parametric test,and chi-square test were performed to compare the differences among the three groups of patients.Results:There were no statistically significant differences in sST2,NT-proBNP,6MWT,KCCQ,LVEF,LVEDD,LVMI,liver and kidney function,electrolytes,and heart rate(HR)among the three groups of patients at the time of enrollment.At one-month follow-up,the 6MWT(Borg-Scale symptom score)of patients in the ARNI group was lower than that in the ACEI and ARB groups,and the difference was statistically significant(P<0.05).There were no significant differences in sST2,NT-proBNP,KCCQ,HR and adverse reactions between the three groups(P>0.05).There were no significant differences in sST2,NT-proBNP,6MWT,KCCQ,LVEF,LVEDD,LVMI,HR,adverse events readmission rates,and mortality at the three-month follow-up(P>0.05).At the six-month follow-up,the sST2 and 6MWT(Borg-Scale symptom score)of patients in the ARNI group were lower than those in the ACEI and ARB groups.The differences were statistically significant(P<0.05).There were no significant differences in NT-proBNP,KCCQ,LVEF,LVEDD,LVMI,HR,readmission rate and mortality between groups(P>0.05).At the twelve-month follow-up,the sST2,LVMI,6MWT(Borg-Scale symptom score),and KCCQ of patients in the ARNI group were better than those in the ACEI and ARB groups,and the differences were statistically significant(P<0.05).There were no significant differences in NT-proBNP,KCCQ,LVEF,LVEDD,LVMI,HR,adverse reactions,readmission rates,and mortality between groups(P>0.05).Conclusions: Compared with ACEI/ARB,ARNI can further inhibit the ventricular remodeling process,improve the symptoms of heart failure,and improve the quality of life in patients with chronic HFrEF.There is no significant difference in safety,reduction in readmission rate,and mortality.