| Objective:Objective To retrospectively analyze the effects of sacubitril/valsartan on myocardial markers and cardiac remodeling in patients with heart failure without decreased ejection fraction.Methods:Objective to collect the information of patients with non ejection fraction reduced heart failure(non-HFrEF)hospitalized in the Department of Cardiology,Shengjing Hospital,China Medical University from November 2016 to February 2021.They were divided into two groups: angiotensin receptor enkephalinase inhibitor(ARNI)group and renin angiotensin system inhibitor(RASI)group.Patients in ARNI group were treated with sacubitril/valsartan(Entresto,Beijing Novartis Pharmaceutical Co.,Ltd.,national drug approval word: h20170344)at a dose of 25mg-100mg/d,twice a day.The dose was adjusted according to the patients’ blood pressure,tolerance and the wishes of patients.RASI group received anti heart failure treatment guided by the guidelines,and adjusted the treatment according to the patient’s condition.Both groups had complete follow-up data.The changes of cardiac remodeling indexes(echocardiography),myocardial markers(NT-proBNP,hsTNT),NYHA grade,systolic blood pressure,heart rate,liver function,renal function,serum potassium ion,glycosylated hemoglobin were observed in non-HFrEF patients.Statistics of adverse reactions during the medication: 1,hypotension: systolic blood pressure lower than 90 mm Hg;2.Hyperkalemia: blood potassium ≥ 5.5mmol/l;3.Abnormal renal function: more than 50% increase in serum creatinine;4.Angioneurotic edema;5.Dry cough.Results:A total of 86 patients with non-HFrEF were enrolled,including 43 patients in ARNI group with a median follow-up time of 88 days and 43 patients in RASI group with a median follow-up time of 81 days.The results are as follows:1.Compared with baseline,the LVEF(48.75±7.50% vs 52.88±8.73%,P = 0.027)of ARNI group after treatmentwas significantly increased,left ventricular end diastolic diameter(LVEDD)(55.20±5.34 mm vs 52.72±6.31 mm,P=0.045)was significantly decreased.NT-proBNP(2990.00(807.60,5200.25)pg/ml vs 1282.00(553.55,3682.50)pg/ml,P=0.014)and hsTNT(0.04(0.02,0.48)ug/L vs 0.02(0.01,0.04)ug/L,P=0.033)decreased significantly.Blood pressure(123.0±26.0 mm Hg vs 114.0±22.0mm Hg,P=0.017),heart rate(81.0 ± 21.0 bpm vs 74.0 ± 13.0 bpm,P=0.043)decreased significantly.In ARNI group,there were no significant changes in NYHA grade.2.Compared with baseline,the left atrial diameter(LAD)(44.72±7.87 mm vs47.53±10.99 mm,P=0.042)of RASI group after treatment was significantly increased.NT-proBNP(2355.00(845.48,7856.75)pg/ml vs 1502.00(428.03,6446.50)pg/ml,P=0.026)and direct bilirubin(3.80(2.73,5.05)umol/L vs 3.20(2.38,4.95)umol/L,P=0.041)decreased significantly.In RASI group,there were no significant changes in NYHA grade.3.Comparison of curative effect between the two groupsCompared with RASI group,the LVEF(2.00(-2.00,10.00)% vs-1.00(-5.00,2.75)%,P = 0.010)of ARNI group was significantly increased,LAD(-2.00(-6.50,3.00)mm vs 3.00(0.00,5.75)mm,P = 0.008),and LVEDD(-2.00(-7.00,2.50)mm vs 0.00(-2.75,3.00)mm,P = 0.042)were significantly decreased.4.SecurityThe incidences of systolic blood pressure lower than 90 mm Hg in ARNI group and RASI group were 14% and 2% respectively(P = 0.110),the incidences of serum potassium≥5.5mmol/l in two groups were 2% and 0% respectively(P = 1.000),and the incidences of serum creatinine level higher than 50% in two groups were 2% and 2%respectively(P = 1.000).There were no adverse events of angioneurotic edema and dry cough in the two groups.Conclusion:compared with RASI,sacubitril/valsartancan significantly reduce the NT-proBNP and hsTNT levels of patients with non-HFrEF,improve the heart structure of patients,and the short-term application is relatively safe,but no improvement of NYHA grade was observed. |
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