Effect Of Sacubitril-valsartan On Pulmonary Arterial Pressure In Patients With Heart Failure:a Meta-analysis

Objectives:.Systemic evaluation of the effect of LCZ696 on pulmonary artery pressure in patients with heart failureMethods:.Databases Pub Med、EM-Base、The Cochrane Library、Wanfang,、VIP、CNKI、 CBM were electronically searched for the study about the treatment of patients with heart failure with LCZ696 from the establishment of the database until February 2021.Literature was screened and data extracted by two researchers according to inclusion and exclusion criteria.Cochrane bias risk assessment method was used to evaluate the quality of RCT literatures.and the Newcastle-CHtawa Scale scale was used to evaluate the literature quality of case series.WMD and 95%CI were used as pooled statistics for Meta-analysis using Rev Man 5.3 software.Results: A total of 10 clinical trials were included,including 4 randomized controlled trials and 6 case-seris trials.Meta-analysis results showed that:1.PASP,LVEDD,RVEDD,NT-pro BNP and ET-1 in LCZ696 group were significantly lower than those in ACEI/ARB group,[MD=8.14,95%CI(7.05,9.23),P<0.00001],[MD=2.86,95%CI(2.24,3.47),P<0.00001],[MD=2.32,95%CI(1.80,2.84),P<0.00001],[MD=7.06,95%C(I 6.18,7.94),P<0.00001],[MD=26.61,95%CI(25.59,27.45),P<0.00001]。2、LVEF、6WMD in LCZ696 group was significantly higher than that in ACEI/ARB group[MD=-2.39,95%C(I-2.79,-2.00),P<0.00001],[MD=-55.41,95%CI(-83.09,-27.73),P<0.00001]。3、After LCZ696 treatment,PASP decreased significantly from baseline at 3 months,3-6months,and 6-12 months.[MD=15.56,95%CI(8.40,22.73),P<0.0001],[MD=5.38,95%CI(1.86,8.90),P=0.003],[MD=4.57,95%CI(2.94,6.19),P<0.00001]。There was no significant decrease in PASP after LCZ696 treatment for3 months and 6-12 months.[MD=1.08,95%CI(-2.92,5.07),P=0.60]。Conclusions: LCZ696 has the effect of decreasing PASP in the near future,and its effect on pulmonary artery pressure is not sustained.LCZ696 reduces pulmonary vascular resistance by decreasing left ventricular filling,but cannot directly affect pulmonary vessels.LCZ696 can reduce PASP better than ACEI/ARB,and can improve cardiac remodeling in patients with heart failure,and the remodeling effect is better than ACEI/ARB.LCZ696 significantly reduced ET-1 level compared with ACEI/ARB group.