Clinical Efficacy Of Sacubitril/Valsartan In Dialated Cardiomyopathy With HFrEF

ObjectiveTo observe the comparative advantages of Sacubitril-Valsartan and Enalapril in the treatment of dilated cardiomyopathy with reduced score heart failure,and to explore the clinical value of Sacubitril-Valsartan.MethodsThis study was a retrospective study.The patients with dilated cardiomyopathy with reduced score heart failure who were admitted to the Department of Cardiovascular Medicine,Changsha Hospital Affiliated to Hunan Normal University from January 2019 to June 2020 were selected as the study subjects.The 97 included patients were divided into 2 groups according to different treatment methods.The first group consisted of a total of 44 patients in the Sacubitril-Valsartan test group（mean dose 100mg/time）,with a mean age of（72.5±12.4）years.The second group consisted of a total of 53 patients in the Enalapril control group（mean dose10 mg/day）,with a mean age of（71.5±11.4）years.The related indexes of the two groups before and after the first month,the third month and the sixth month were statistically analyzed:（1）heart rate,blood pressure;（2）serum NT-pro BNP level;renal function（BUN,Cr）,liver function（ALT,AST）,uric acid（UA）;（3）Left ventricular ejection fraction（LVEF）,Left ventricular end diastolic diameter（LVEDd）;（4）NYHA functional classification;（4）6-Minute Walk distance（6 MWT）;（3）adverse events（hypotension,hyperkalemia,renal impairment,angioedema,etc.）.Results1.Baseline indicators:There was no significant difference in gender,age,smoking history,basic diseases（hypertension,hyperlipidemia,diabetes）and drug use between the two groups（P>0.05）.2.Main efficacy indicators:2.1 There was no significant difference in NT-pro BNP,uric acid,LVEF,LVEDd,NYHA functional classification and 6 MWT between the two groups before treatment（P>0.05）;2.2 The levels of NT pro BNP,LVEF and uric acid in the experimental group were lower than those in the control group from the third month of treatment,and the differences were statistically significant(P_{NT-pro BNP}=0.00,P_LVEF=0.047,P_{uric acid}=0.00).2.3 The 6MWT and NYHA cardiac function grades in the test group were significantly improved at the third month of treatment,which were better than those in the control group(P_6-MWT=0.025,P_NYHA=0.032);2.4 LVEDd in the test group was significantly lower than that in the control group at the 6th month,P_LVEDd=0.008,the difference was statistically significant。3.Safety indicators:3.1 There was no significant difference in heart rate,blood pressure,liver function（ALT,AST）,renal function（BUN,Cr）between the two groups before and after treatment（P>0.05）.3.2 During treatment,a total of 4 events of hypotension and 3 events of renal insufficiency occurred.After statistics,the incidence rate of adverse reactions was 4.55%in the test group and 9.43%in the control group.There was no significant difference between the two groups（P>0.05）.Conclusion1.Compared with Enalapril,Sacubitril-Valsartan further reduces the left ventricular end diastolic diameter,increases the left ventricular ejection fraction and reverses myocardial remodeling in patients with dilated cardiomyopathy and HFr EF.2.Sacubitril-Valsartan has no serious adverse reactions in the treatment of dilated cardiomyopathy HFr EF,medication safety.