Self-control Study On The Clinical Efficacy Of Sacubitril/Valsartan In Patients With Heart Failure With Reduced Ejection Fraction

Objective:To explore the efficacy and safety of Sacubitril/Valsartan in the treatment of heart failure patients with reduced ejection fraction in the real world by clinical data of 6 months before and after treatment.Methods:From January 2019 to June 2020,120 patients with heart failure with reduced ejection fraction were selected from the cardiovascular ward and outpatient department of the First Affiliated Hospital of Kunming Medical University.Baseline information including blood pressure,heart rate,blood biochemistry,cardiac ultrasound,cardiac magnetic resonance and clinical medication were recorded before using Sacubitril/Valsartan.After 6 months of follow-up,the blood pressure,heart rate,blood biochemistry,cardiac ultrasound,cardiac magnetic resonance,adverse reactions,readmission rate and all-cause mortality of patients were observed.Through statistical analysis,the differences of blood pressure,heart rate,NT-Pro BNP,cardiac function grade,left ventricular ejection fraction,myocardial remodeling index,etc.between patients before and after using Sacubitril/Valsartan for 6 months were compared.Results:A total of 120 patients were included in this experiment,including 81 males(67.5%)and 39 females(32.5%),aged 33-78 years,with an average age of 50.55±12.37 years.(1)Etiology:Dilated cardiomyopathy,ischemic heart disease and hypertensive heart disease were the main causes in this study.77 cases(64.17%)of dilated heart disease(7 cases of alcoholic cardiomyopathy accounted for 9.09%,and 6 cases of perinatal cardiomyopathy accounted for 7.79%).(2)Effectiveness:By comparing NT-Pro BNP,6-minute walking test,cardiac function classification,left ventricular ejection fraction,cardiac color Doppler ultrasound and cardiac magnetic resonance myocardial remodeling index,Minnesota quality of life scale,etc.before medication and 6 months after the use of Sacubitril/Valsartan,the effectiveness in the treatment of heart failure with reduced ejection fraction was comprehensively evaluated.Compared with baseline data,NT-Pro BNP decreased by 1888.50 pg/ml(P<0.05),LVEF increased by 11.8%(P<0.05)by cardiac echocardiography,and LVEF increased by 14.17%(P<0.05)by cardiac magnetic resonance imaging.Moreover,LVEDV,LVESV,LVEDD were lower than before,and the cardiac function grade and 6-minute walking distance were higher than before.(3)Correlation of QRS wave:Compared QRS wave<120 ms groupwith QRS wave≥120 ms group,the NT-proBNP decreased significantly(72.46%VS 28.57%)and LVEF increased significantly(41.46%VS 29.31%),In the QRS wave<120 ms group,the LVEDV decreased by 10.39%(P<0.05)and LVESV decreased by 15.98%(P<0.05),while the numerical changes of LVEDV and LVESV in wide QRS wave group were not statistically significant before and after treatment.The effect of Sacubitril/Valsartan on QRS wave normal group was better than that of wide QRS wave group in improving cardiac function and inhibiting myocardial remodeling.(4)Safety:Compared with baseline data,there was no significant difference in serum potassium and blood glucose after 6 months of using Sacubitril/Valsartan(P>0.05);ALT,AST and serum creatinine decreased(P<0.05).In this experiment,1 patient with hypotension(0.83%),1 patient with renal insufficiency(0.83%),and 2 patients with all-cause death(1.67%)were observed,which indicates that the patient was well tolerated to Sacubitril/Valsartan;(5)Dosage:After 6 months of medication,the final dose reached by patients using Sacubitril/Valsartan was counted.It was found that 12 cases(10.34%)used 25mg po bid,38 cases(32.76%)used 50mg po bid,and 100mg po bid The number of 39 cases(33.62%),150mg po bid 19 cases(16.38%),200mg po bid 8 cases(6.90%)showed that most patients did not use the recommended dose of 200mg po bid.Conclusions:1.Sacubitrial/Valsartan can effectively improve the cardiac function of patients with heart failure with reduced ejection fraction,inhibit myocardial remodeling,improve the quality of life of patients,and has no obvious adverse reactions during treatment;2.The effect of Sacubitril/Valsartan on heart failure patients with normal QRS complex and reduced ejection fraction is better than that of heart failure patients with reduced ejection fraction with broadened QRS complex;3.The maximum dose of Sacubitril/Valsartan at 6 months was mostly 100-150mg bid(accounting for 49.14%of the total number of patients),and less than 200mg bid(accounting for 6.90%of the total number of patients).