Clinical Study On The Effect Of Sacubitril/valsartan On Left Atrial Remodeling In Patients With Heart Failure

Background:Chronic heart failure(chronicheartfailure,CHF))is the final stage of most cardiovascular diseases.Although great progress has been made in the treatment of various cardiovascular diseases in recent years,the prevalence and mortality of heart failure are still very high.The increasing hospitalization rate and mortality rate are closely related to cardiac structural remodeling in the process of heart failure.So far,most of the studies on HF have focused on ventricular remodeling,while much less attention has been paid to the changes of atrial structure and function.In the context of preserves ejection fraction((HFp EF))and a new concept of“Atrial Failure”,more recent attention has been paid to left atrial(LA)remodeling,which is now considered as a potential therapeutic target and an end point for the evaluation of new therapies.ARNI has brought landmark progress to the treatment of heart failure as a new therapeutic drug.It is a new type of angiotensin receptor-enkephalin inhibitor,which has a unique dual regulatory mechanism.It modifies the cardiac remodeling by inhibiting the renin-angiotensin-aldosterone system(RAAS)and regulating the natriuretic peptide system.At present,there are few studies on left atrial structural remodeling.This study was to observe the effect of sacubitril/valsartan on left atrial structural and functional remodeling and prognosis in patients with heart failure.Methods:Retrospectively collected in January 2015 to May 2020 hospitalized in the First Affiliated Hospital of Dalian Medical University and diagnosis of patients with heart failure,the patients were divided into two groups:ARNI group(n=144)and ACEI/ARB group(n=130).The median follow-up time was 17.56±9.34 months,collecting patients’clinical baseline characteristics,biochemical routines,baseline and follow-up echocardiographic indicators(LAD,left atrium four-chamber intracardiac meridian,LVEDD,LVEF,E/e~′),and LAVI,LARR and LASI.Statistical analysis was performed with SPSS 26.0 statistical software to compare the effects of two different therapeutic drugs on left atrium remodeling and prognosis.According to the basic left atrial volume index,it is divided into three group:the left atrial volume index slightly enlarged group(29ml/m~2≦LAVI<34ml/m~2),and the left atrial volume index moderately enlarged group(34ml/m~2≤LAVI<40ml/m~2),Left atrial volume index severely enlarged group(LAVI≥40ml/m~2),to explore the effect of ARNI treatment on left atrial volume index.Results:1.Comparison of left atrial structural remodeling indexes between ARNI group and ACEI/ARB group in patients with heart failure:274 patients were divided into two groups:ARNI group(n=144)and ACEI/ARB group(n=130).The median follow-up time was 17.56±9.34 months.After follow-up,it was found that compared with the ACEI/ARB group,the left atrium diameter,LAVI,LARR and LASI were significantly improved in ARNI group.And also found that decreased ARNI LVEDD≥10mm group and the number of patients with elevated LVEF was significantly higher than ACEI/ARB group.2.Comparison of end-point events between the ARNI and ACEI/ARB groups:The rehospitalization rate in the ARNI group was 59.7%(86/144)was significantly lower than the 71.5%(93/130)rehospitalization rate in the ACEI/ARB group(P=0.004).The all-cause mortality rate was 11.8%(17/144)and was significantly lower than the 27.6%(31/130)in the ACEI/ARB group(P=0.009).With the extension of follow-up time,to 12-24 months,the rehospitalization rate and mortality rate of ARNI group were significantly lower than that of ACEI/ARB group.There was no statistically significant difference in adverse events between the two groups(P>0.05).3.The effect of two groups of drug treatments on the prognosis of patients with heart failure in different degrees of left atrium:we found that the survival status of patients with mild left abnormal treated with ARNI was better than that of ACEI/ARB group(P=0.04).There was no significant statistical difference between the moderate and severe abnormal groups(P=0.57,P=0.52).Conclusions:1.ARNI can reduce LAD,LAVI,LARR and LASI,to reverse atrial remodeling in patients with heart failure.We was found that ARNI can also reduce the left ventricular end-diastolic diameter and increase the left ventricular ejection fraction,reversing left ventricular remodeling.2.Compared with ACEI/ARB group,ARNI significantly reduced all-cause mortality and rehospitalization rate,especially with the extension of follow-up time,it played a more significant role in improving the prognosis of patients with heart failure.