Effects Of Different Doses Of Sacubitril/valsartan On Cardiac Structure And Left Ventricular Function In Patients With Chronic Heart Failure

ObjectiveChronic heart failure（CHF）has become a major and increasingly serious public health problem,and so far it is still an incurable cardiovascular disease.Although there are a variety of drugs to treat CHF,all of them can only slow down its process.Heart failure still has a high mortality rate under the treatment of traditional Golden Triangle drugs.In recent years,the emergence of Sacubitri/valsartan,SV has brought good news to patients with heart failure.According to studies,the application of SV has achieved a good effect in reducing the incidence of cardiovascular adverse events and improving patients’symptoms.However,in clinic,it is found that due to the strong antihypertensive effect of SV,some heart failure patients can not apply SV to the maximum target dose recommended by the guidelines.Therefore,the purpose of this paper is to study the effects of different doses of SV on cardiac structure and left ventricular function in patients with chronic heart failure.MethodsThe patients diagnosed as chronic heart failure in the cardiovascular department of the second affiliated Hospital of Shenyang Medical College from November 2020 to June 2021 were selected as the object of observation.All patients met the New York College of Cardiology（NYHA）cardiac function classification standard II～IV,and the left ventricular ejection fraction（LVEF）≤50%.According to the oral dose of SV and oral SV,the patients were divided into three groups:SV100mg group（n=31）,SV50mg group（n=38）and control group（n=32）,give SV100mg BID,SV50mg BID,ACEI/ARB QD respectively.All the patients were given routine anti-heart failure therapy,such as low-salt diet,diuretics,nitrates,sodium nitroprusside,cardiotonic agents,β-blockers and so on.The control group was given oral ACEI/ARB on the basis of routine anti-heart failure once a day,and the treatment group was given oral SV on the basis of routine treatment,twice a day.All patients were followed up for 6 months.The renal function,NT-pro BNP and other biochemical indexes on admission and 6 months later,the related indexes of cardiac structure and left ventricular function reflected by cardiac color ultrasound,blood pressure and adverse reactions were recorded.The data of this study were statistically analyzed by SPSS26.0software,and the measurement data were tested for normal distribution and variance homogeneity.The measurement data consistent with normal distribution were expressed by mean addition and subtraction standard deviation（（?）±s）.Independent sample t-test was used for inter-group comparison,single-factor analysis of variance was used for multi-group comparison,and non-parametric test was used for data that did not conform to normal distribution.The correlation between each index and dose was analyzed by linear regression test.The counting samples were compared by chi-square test.The difference of all tests was statistically significant（P<0.05）.Results一.comparison of general clinical dataThere was no significant difference in age,sex,blood lipids,smoking history,family history,coronary heart disease,cardiomyopathy,hypertension,diabetesanddiuretics,ACEI/ARB,nitrates,sodium nitroprusside,cardiotonic agents andβ-blockers among SV100mg group,SV50mg group and control group（P>0.05）.Echocardiographic indexes of SV100mg group,SV50mg group and control group before treatment:left atrial meridian（LAD）,left ventricular end-diastolic internal meridian（LVEDD）,LVEF,left ventricular end-diastolic volume index（LVEDVI）,left ventricular end-systolic volume index（LVESVI）,left ventricular mass index（LVMI）.No statistical meaning（P>0.05）.There was no significant difference in serum indexes of N-terminal pro-brain natriuretic peptide（NT-pro BNP）,Cardiac troponin I（c Tn I）,creatinine clearance（Ccr）and K⁺（P>0.05）,and there was no significant difference in systolic blood pressure（SBP）among the three groups（P>0.05）.二.Treament effect1.The comparison between the SV50mg group and the control group after treatment showed that there was significant difference between the LVEF groups after 6 months of treatment（P<0.05）.Other cardiac color ultrasound indexes such as LAD,LVEDD,LVEDVI,LVESVI and LVMI in the SV50mg group were lower than those in the control group,but there was no statistical significance（P>0.05）.The level of NT-pro BNP in the SV50mg group was lower than that in the control group（P<0.05）.The level of c Tn I in SV50mg group was lower than that in control group,but there was no statistical significance（P>0.05）.2.After 6 months of treatment,Comparison between SV50mg group and SV100mg group,the LVEF of SV100mg group was significantly higher than that of SV50mg group,which was statistically significant（P<0.05）.The values of LAD,LVEDD,LVEDVI,LVESVI and LVMI in SV100mg group were lower than those in SV50mg group,but there was no statistical significance（P>0.05）.The levels of NT-pro BNP and c Tn I in SV100mg group were lower than those in SV50mg group,but there was no statistical significance（P>0.05）.3.Six months after treatment,compared with the control group,the LVEF in the SV100mg group was significantly higher than that in the control group（P<0.01）.Other cardiac color ultrasound indexes such as LAD,LVEDD,LVEDVI,LVESVI and LVMI in the SV100mg group were significantly lower than those in the control group（P<0.05）.The level of NT-pro BNP in the SV100mg group was significantly lower than that in the control group（P<0.05）.The level of c Tn I in SV100mg group was significantly lower than that in control group（P<0.05）.4.The correlation between LVEF,NT-pro BNP and drug dose in SV50mg group after 6 months of treatment was analyzed by univariate linear regression.The results showed that there was a significant correlation between the dose of SV and the values of LVEF and NT-pro BNP in SV50mg group after 6 months of treatment（P<0.05）.Similarly,the correlation between LAD,LVEDD,LVEF,LVEDVI,LVESVI,LVMI,NT-pro BNP,c Tn I and drug dosage in SV100mg group was analyzed by univariate linear regression statistical method.The results showed that the dose of SV was correlated with the values of LAD,LVEDD,LVEF,LVEDVI,LVESVI,LVMI,NT-pro BNP and c Tn I in SV100mg group after 6 months of treatment（P<0.05）.三.Comparison of adverse reactionsIn the course of treatment,there were 2 cases of symptomatic hypotension,1 case of K⁺>5.5mmol/L and 1 case of cough in SV100mg group,1 case of symptomatic hypotension and 1 case of cough in SV50mg group,and 2 cases of K⁺>5.5mmol/L and 2 cases of cough in control group.The adverse reactions of the patients were mild,so they could continue to use the drug after reducing the dose or stopping the drug for 3 days.There was no significant difference in adverse reactions among the three groups（P>0.05）.Conclutions1.SV can improve cardiac structure and left ventricular function in patients with CHF.2.The improvement of cardiac structure and left ventricular function in CHF patients was correlated with the dose of SV.With the increase of SV dose,the improvement of cardiac structure and left ventricular function in CHF patients was more obvious.3.There was no difference in drug safety among the three groups.