Study On The Clinical Efficacy Of HFrEF Patients With Renal Insufficiency In Dapagliflozin

Objective:To study on the clinical efficacy of HFr EF patients with renal in sufficiency in dapagliflozin.Methods:From November 2020 to December 2021,the patients who were treated in the Department of Cardiovascular Medicine of the Affiliated Hospital of Yanda University because of HFr EF with renal insufficiency.Those patients should meet the adult patients of age less than 80,LVEF<40%,heart functio n grade of NYHAⅡorⅢ,Ⅳ,and NT-proBNP increase,e GFR>30ml/min/1.73m~2.Those patients were divided into 2 groups,30 patients were in the obser vation group and 28 patients blong to the control group.The control group was given the most rationalized anti-HF medicine,they include diuretics,ACEI/A RB/ARNI,β-blockers,and spironolactone.When the condition is serious,we also gave lyophilized recombinant human brain natriuretic peptide,levosimendan,even instrumental adjuvant therapy.Patients with diabetes are given the most re asonable hypoglycemic regimen,Including grenclass,DPP-IV inhibitors,acarbos e,metformin,insulin,GLP-1 receptor agonist.The treatment regimen of the obs ervation group is based by adding 10mg dapagliflozin daily(Astra Zeneca Pharm aceutical Co,Ltd,Sinopharm quasi word J20170040)to the control group.58 pat ients were evaluate for cardiac ultrasound and laboratory indicators at admissi on and 3 months after treatment.At the same time,we should follow up the pat ients’medication,body weight,blood pressure,heart rate,blood sugar,and clin ical symptoms every month by phone or SMS.Furthermore,we collected labora tory indicators and cardiac function evaluation indicators which came form adm ission and 3 months after discharge.They would incloud creatinine,glyification,blood glucose,serum potassium,serum sodium,erythrocyrit,NT-proBNP,dista nce of the 6-MWT and LVEDD,LVESD,LVEF of UCG.Finally,we compre hensively evaluated the clinical effect of dapagliflozin on patients with HFr EF with renal inadequacy.Results:1.Comparison of the basic condition of patients in the two group s:one patient in the observation group lost contact and one patient in the cont rol group lost contact.Therefore,toward the finish of this preliminary,there w ere 30 patients in the observation group and 28 patients in the control group.The age,sex,weight,blood pressure,causes of heart failure,diabetes medicati on,heart failure medication,laboratory examination,echocardiography and 6-M WT were analyzed on admission.There was no significant difference in all ba seline data.2.Comparison of LVEDD between the two groups:the LVEDD of the co ntrol group and the observation group before treatment were with no statistica l difference.After treatment,they all decreased,but the observation group decre ased more significantly than the control group and it was statistically significan t.In this experiment,the patients with diabetes in the control group and the o bservation group and the patients without diabetes in the control group and the observation gathering were tested,additionally.The comparison between the s ubgroups was carried out,and it was found that regardless of whether there w as diabetes,the LVEDD of the observation group diminished essentially contras ted and the control group,with statistical significance.3.Comparison of LVESD between the two groups:the LVESD of the cont rol group and the observation group were with no significant difference,and the LVESD after treatment were with no significant difference.The patients with diabetes and those without diabetes in the control group and the observation gr oup were isolated into subgroups,and there was no factual distinction between the two gatherings after treatment.4.Comparison of LVEF between the two groups:the LVEF of the control group and the observation group before treatment were with no significant diff erence.Atter treatment,there was a tremendous distinction between the two gat herings.The patients with diabetes and those without diabetes in the control group and the observation group were separated into subgroups for perception.The improvement of LVEF of the patients with diabetes and those without dia betes in the observation group was higher than that in the control group,with measurable importance.5.Comparison of 6-MWT between the two groups:the 6-MWT of the co ntrol group and the observation group before treatment were no significant diff erence.After treatment,the 6-MWT of the two patients were increase but the distance of the observation group were higher than those of the control group.The 6-MWT of the patients with and without diabetes in the control group an d the observation group were noticed individually,and it was observed that the helpful impact of the observation group was essentially higher than that of th e control group.6.Comparison of NT-proBNP between the two gatherings:the control and observation groups in NT-proBNP before treatment were no statistical differen ce.There were statistical differences in NT-proBNP after treatment between the two groups.In particular,the observation group decreased more significantly.W e classified the patients in the control and observation groups into patients wit h diabetes and without diabetes,respectively,they were statistically significant after treatment.7.Comparison of other laboratory indexes:in the experiment,some other la boratory indexes included in the patients were also compared.It was observed that the body weight and systolic pulse of the patients in the dapagliflozin bun ch were essentially lower than those in the group.The hematocrit in the obse rvation group was higher than that in the control group.There was huge disti nction in Hb A1c between the observation group and the control group.There was no huge distinction in the degree of abatement in non-diabetes patients.T here was no significant difference in creatinine decrease and e GFR improvemen t between the observation group and the control group.There was no tremendo us distinction in other lab files.8.Adverse events and adverse drug reactions:among all the patients in thi s study,there was one death because of cardiovascular disease in the control g roup and one case in the observation group,and two cases in the control grou p and one case in the observation group because of intense cardiovascular brea kdown.Acute myocardial infarction,stroke and malignant arrhythmia were foun d in all patients during the follow-up of 3 months.In the antagonistic medicati on responses,there were one cases in the control group and two cases in the observation group,all of which happened in patients with diabetes.No urinary tract infection,reproductive tract infection,diabetic ketoacidosis,severe hypoten sion,fracture,hypovolemia and other events were observed in both groups.Conclusion:Dapagliflozin can improve LVEDD,increase LVEF,decrease NT-proBNP and increase the distance of 6-MWT in patients with heart failure with reduced ejection fraction and renal insufficiency,and it is safe,and there is no obviou s adverse reaction in the 3-month observation period.