Analysis Of Mild Moderate-Dose Shakubatri-Valsartan In The Treatment Of Ejection Fraction Reduction In Heart Failure

Background and purpose:Heart failure(HF)is the superimposed effect and end-result of ingravescence of cardiac structure and function caused by various protopathic heart diseases or systemic diseases involving the heart 1.It is a group of clinical syndromes with different pathophysiology.The morbidity and mortality rate is the highest in cardiovascular disease.Heart failure is classified by ejection fraction into ejection fraction with preserved heart failure(EFp HF),ejection fraction median heart failure(EFmr HF),and ejection fraction with reduced heart failure(EFr HF).Among them,the pathogenesis of EFr HF is the most clearly studied,of which the two most important systems were the renin-angiotensin-aldosterone system(RAAS)and the natriuretic peptide system(NPS).NPs combine with their receptors(natriuretic peptide receptor NPR)to exert biological effects,produce natriuretic and diuretic and vasodilator effects,inhibit fibroblast proliferation and myocardial hypertrophy,inhibit RAAS and SNS activity,and regulate body energy metabolism.Therefore,increasing the amount of NPs in the body of patients with heart failure or reducing its degradation can exert biological effects.NPs are mainly degraded by enkephalinase in the body,and inhibiting the concentration of enkephalinase in the body has become a target for treatment of heart failure.RAAS is expressed in all organs of the body and is involved in the regulation of cardiovascular activities through local effects,mainly the release of angiotensin Ang Ⅱ,which regulates heart rate and blood pressure by promoting the release of noradrenaline in sympathetic nerve endings.In the peripheral vessels through the systolic arterioles,increase blood pressure,systolic arterioles to promote blood return;Promote the release of aldosterone,maintain the circulation of blood volume.Aldosterone increases the volume of circulating blood and increases the burden on the heart.Therefore,antagonistic RAAS can reduce cardiac burden and inhibit or reverse ventricular remodeling.Sacubitril Valsartan(the LCZ696 ARNI)for enkephalin enzyme inhibitors and angiotensin receptor antagonist compound preparation,inhibit enkephalin enzyme system and RAAS system improve the ventricular remodeling,but some NYHAIII-IV level in patients with low blood pressure,giving LCZ696high-dose when starting doses can cause symptomatic hypotension,so this study is to give medium dose and small dose LC2696 and after the treatment of heart,effect of NT-proBNP failure and changes of cardiac function indexes.Method:The First Affiliated Hospital of Hebei North University was selected from October 2018 to 2020.01 of cardiovascular internal medicine outpatient and hospitalization NYHA Ⅲ～Ⅳ EFr HF patients a total of 69 people,taking respectively LCZ69650 mg BID(19)and 100 mg BID(25),and 10 mg QD enalaprilat(25).General clinical data of patients were collected,including name,age,gender,heart rate,blood pressure,stature,weight,clinical observation indicators: NT-proBNP,ultrasound cardiac function indicators,anamnesis,biochemical detection,and basic medication.The patients were followed up for 3,6 and 12 months.Spss26.0 software was used to process the relevant data.The measurement data were expressed as mean ± standard deviation((?)±s).Three independent samples t test was used to compare the differences of cardiac function and laboratory indexes among the three groups.Enumeration data was expressed as percentage(%),and chi square test was used for comparison among the three groups,with statistical significance(P < 0.05).Result:1.NT-proBNP in patients with acute heart failure was significantly increased by 2964.00(1775.504754.00),and the three groups were improved after treatment,and the longer the treatment time,the more obvious the improvement effect was 102.00(18.00461.50).2.Compared with before treatment,the UCG of Sacubitril Valsartan medium dose(100mg BID),Sacubitril Valsartan low dose(50mg BID)and enalapril group(10mg QD)all improved,and the improvement effect of Sacubitril Valsartan medium dose group was more obvious than that of the low dose group and enalapril group.In conclusion:1.In the inhibition of myocardial remodeling,shakubactrovalsartan was more effective than enalapril.2.In terms of improving cardiac ultrasound function indexes and clinical symptoms,the higher the dose of shakubactrevalsartan,the better the effect,but it should be determined according to the patient’s blood pressure tolerance.