The Effect Of Sacubitril Valsartan On Left Ventricular Remodeling After Valve Replacement

Objective:To understand the changes of left ventricular remodeling in patients with valvular heart disease,and to explore the effect of sacubitril and valsartan on left ventricular remodeling.Method:1.The first part retrospectively selected 60 patients who underwent heart valve replacement in Chengdu Second People’s Hospital and were followed up regularly for two years with complete data.According to whether left ventricular end diastolic dimension（LVEDD）returned to normal level in two years after operation,they were divided into group A and group B.Group A showed that LVEDD did not return to normal level,In group B,LVEDD returned to normal level.A cut-off value was obtained by ROC curve analysis of LVEDD of group A and group B.2.In the second part,a prospective non-randomized concurrent controlled trial was adopted.According to the inclusion and exclusion criteria,patients who chose to use sacubitril and valsartan after surgery were classified as the experimental group（group A）,patients who did not use sacubatril and valsartan were classified as the control group （group B）.The trial included 60 patients,including 25 in group A and 35 in group B.After being excluded by the inclusion and exclusion criteria,23 patients were finally included in group A and 34 patients in group B.Patients in group A with LVEDD>CUT-OFF value were defined as group D,and patients in group B with LVEDD>CUT-OFF value were defined as group E.3.Medication method（in the second part）:starting from the 10th day after operation,the initial dose was 50mg bid,and the drug dose was doubled every two weeks until the target maintenance dose of 200mg bid was reached.4.Measurement indexes（in the second part）:（1）LVEDD:all patients in group A and group B who met the inclusion and exclusion criteria were measured by echocardiography one week before operation（T₀）.The patients were followed up for 1 month（T₁）,3 months（T₂）and 6 months（T₃）after they were discharged from the hospital.The echocardiography and LVEDD data were collected.The left ventricular long axis section near sternum was selected to measure LVEDD by echocardiography probe,and the left ventricular remodeling was found when the diameter was more than 55mm.（2）NT-pro BNP:the concentration of NT-pro BNP should be checked at the same time when checking cardiac color Doppler ultrasound.Venous blood was collected and sent to the laboratory of our hospital to get the relevant values.Results:1.ROC curve analysis in the first part was performed according to the preoperative LVEDD data of group A and group B and the cut-off value was 64 mm. When preoperative LVEDD>64mm,it is difficult for LVEDD to return to normal level within two years after operation.2.Both groups A and B in the first part showed a downward trend in LVEDD.In group A,it was up to 6 months.LVEDD still did not return to the normal level at 1 month,but the decline reached the optimal level.After 6 months,the decline of LVEDD was extremely slow;in group B,LVEDD had shrunk to within the normal range by 6 months,and the decrease reached the best level.After 6 months,the decline in LVEDD was significantly slowed.3.Repeated measures analysis of variance of LVEDD of patients in groups A and B（in the second part）:LVEDD of patients in groups A and B showed an overall downward trend compared with before operation.Among them,patients in group A continued to decrease after operation,while patients in group B also showed a decrease after operation.Trend, but the rate of decline is extremely slow.During the T₂-T₃period,the LVEDD of group A began to decrease continuously.At the T3 time point,the LVEDD of the two groups of patients was P=0.02<0.05,and there was a statistical difference in the LVEDD of the two groups of patients.4.Repeated measurement analysis of variance of N-Terminal pro-brain natriuretic peptide（NT-pro BNP）of patients in groups A and B（in the second part）:NT-pro BNP of patients in groups A and B is generally decreasing,among which The NT-pro BNP of A group continued to decline in all stages of the measurement,while the NT-pro BNP T₀-T₁of group B increased,while T₁-T₃continued to decline,and the decrease of group A was greater than that of group B.The P at the three time points of T₁,T₂,and T₃were 0.002,0.001,<0.001,all less than 0.05,which was statistically significant.There were statistically significant differences in NT-pro BNP between the two groups.5.Comparison of the rehospitalization rate of patients in groups A and B（in the second part）:The chi-square test results of the two groups were statistically different （P=0.04<0.05）.The rehospitalization rate of patients in group B was 6.76 times that of patients in group A.6.Analysis of variance of repeated measures of LVEDD and NT-pro BNP in groups A and C:The overall LVEDD of patients in groups A and C showed a downward trend.Among them,patients in group A continued to decline in LVEDD,and patients in group C had very little change in LVEDD before T₂.However,there is a downward trend in the T₂-T₃time period.There were statistical differences in LVEDD between groups A and C at T₁,T₂,T₃and time points.The NT-pro BNP of patients in groups A and C showed a downward trend,and both groups continued to decline.There were statistical differences in NT-pro BNP between A and C groups at T₂,T₃and time points.7.Analysis of variance of repeated measures of LVEDD and NT-pro BNP in the D and E groups:The NT-pro BNP of the D and E groups showed a downward trend,but the decrease in the D group was more significant than that in the E group at the same time;the D group patients LVEDD showed a downward trend,while LVEDD in group E did not change significantly.There were statistical differences in LVEDD between the two groups at T₃（P=0.04）,NT-pro BNP at T₂（P=0.03）and T₃（P=0.01）were statistically different,and the postoperative rehospitalization rate（P=0.03）)There is a statistical difference.Conclusion:1.In patients with valvular disease before surgery,when LVEDD is greater than 64 mm,it is difficult to recover postoperative ventricular remodeling.2.Sacubitril and valsartan can help patients after heart valve surgery to improve ventricular remodeling,improve heart function,and reduce the rate of rehospitalization.3.Under the intervention of sacubitril and valsartan,surgical valve replacement can accelerate the reversal of ventricular remodeling in patients with heart valve disease and ventricular remodeling.4.When the patient’s LVEDD is greater than 64mm before surgery,the intervention of sacubitril and valsartan after heart valve replacement can reverse ventricular remodeling.