| Objective: To investigate the improvement of sacubitril-valsartan on ventricular remodeling and short-term cardiac function in patients with chronic heart failure,differences in the short-term prognosis of sacubitril valsartan in patients with chronic heart failure with different genotypes of neprilysin(rs3736187)and AT-1R(A1166C).Methods: A total of 131 patients with chronic heart failure who were hospitalized for different causes from October 2021 to September 2022 selected.Since the CC genotype was not detected at the neprilysin(rs3736187)and the CC genotype was not detected at the AT-1R(A1166C),the patients were divided into TT or TC group according to the gene polymorphism of neprilysin and AA or AC group according to the gene polymorphism of AT-1R.Clinical data of patients at admission were collected: age,sex,etiology,NYHA cardiac function classification,NT-pro BNP,biochemistry(serum creatinine,serum potassium,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase),myocardial enzymes(creatine kinase,CK-MB,lactate dehydrogenase),infection markers(procalcitonin,interleukin-L6),blood routine(platelet/lymphocyte ratio,neutrophil/lymphocyte ratio,erythrocyte width-SD,platelet volume,platelet fraction Cloth width),cardiac color ultrasound index:Left ventricular ejection fraction(LVEF),Left ventricular end-systolic diameter(LVDS),Left ventricular end-diastolic diameter(LVDD),Left atrial diameter(LA).Patients were treated with Sacubitril-Valsartan and other drugs for heart failure.After discharge,patients were followed up for 3 months by outpatient department or telephone,and cardiac color doppler ultrasound,NT-pro BNP and cardiac function grading of patients were recorded during the period.To analyze the differences in short-term prognosis after treatment with sacubitril-valsartan in patients with chronic heart failure with different genotypes.Results: In patients with chronic heart failure,neprilysin(rs3736187)genotype frequency was TT(84%),TC(16%),CC(0%)and AT-1R(A1166C)genotype frequency was AA(90%),AC(10%),CC(0%).Age,etiology,NYHA heart function classification,NT-pro BNP,cardiac ultrasound indexes,blood routine,infection markers,myocardial enzymes of the each groups were compared had no significant differences(P>0.05),patients with the TT genotype of neprilysin had higher levels of alkaline phosphatase than TC genotype,AA genotype of AT-1R had higher levels of alanine aminotransferase and aspartate aminotransferase than AC genotype.After 3 months of follow-up,there was no statistical difference in the titrated dose of Sacubitril-Valsartan between different groups(P < 0.05).After treatment with sacubitril valsartan,the effective rate of TT genotype was 56.19%,the effective rate of TC genotype was 53.84%;the effective rate of AA genotype was 59.09%,the effective rate of AC genotype was 38.09%,but there was no statistical difference in the response rate of patients with different genotypes for the improvement of heart function classification after treatment with sacubitril-valsartan.There were significant differences in LVEF,LVDD,LVDS and NT-pro BNP in patients with TT genotype of neprilysin after 3months of follow-up(P < 0.05),there were significant differences in NT-pro BNP in patients with TC genotype of neprilysin after 3 months of follow-up(P < 0.05).However,there was no significant differences in heart function classification,cardiac ultrasound index and the NT-pro BNP between the groups of neprilysin gene polymorphism(P>0.05).There were significant differences in LVEF,LVDD,LVDS and NT-pro BNP in patients with AA genotype of AT-1R after 3 months of follow-up(P < 0.05),there were significant differences in LVEF in patients with AC genotype of AT-1R after 3 months of follow-up(P < 0.05).However,there were no significant differences in heart function classification,cardiac ultrasound indexes and NT-pro BNP between the groups of AT-1R gene polymorphism(P>0.05).The neprilysin gene polymorphism and AT-1R gene polymorphism were pairwise matched and divided into four groups,there were no significant differences in cardiac function indexes between the four groups of patients with different genotypes before treatment,and there were no significant differences in cardiac function indexes after 3 months of follow-up of patients with different genotypes of heart failure treated with sacubitrilvalsartan(P > 0.05).Conclusions: Chronic heart failure treated with sacubitril-valsartan had an increase in cardiac function grades,improved cardiac ultrasound indicators,and decreased NT-pro BNP levels,Sacubitril-valsartan can effectively reverse ventricular remodeling in patients with chronic heart failure,and improve the short-term prognosis of patients,but there was no significant difference between neprilysin(rs3736187)and AT-1R(A1166C)in patients with chronic heart failure with different genotypes for the short-term prognosis of sacubitrilvalsartan in the treatment of heart failure,and there is no synergistic effect of two genetic polymorphisms. |
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