Effects Of Initiating Sacubitril/Valsartan Early On Plasma Apelin In Patients With Acute Myocardial Infarction Complicated With Cardiac Insufficiency

Objective The goal of this study is to explore how plasma Apelin concentrations change after initiating sacubitril/valsartan in patients with acute myocardial infarction complicated with cardiac insufficiency in the early stages after myocardial infarction,that is,before patients suffer from obviously adverse ventricular remodeling that follows myocardial infarction.Methods This study enrolled 146 patients with acute myocardial infarction complicated with cardiac dysfunction at The First Hospital of Jiaxing from August 2021 to January 2022.Patients were randomly assigned in a 1:1 ratio to one of two groups:valsartan or sacubitril/valsartan.At enrollment,relevant baseline data were collected,and patients were followed up with 13 and 25 weeks later.At baseline,13,and 25 weeks,plasma Apelin-13 and Apelin-36 concentrations were compared between the two groups.The plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),and left ventricular end-diastolic diameter(LVEDD)were compared between the two groups at the above three time points.During the entire study period,major adverse cardiovascular events(MACE)were recorded.To test for changes in the above quantitative measures,generalized estimating equation models were used.The occurrence of MACE in the two groups was described using Kaplan-Meier analysis.The researchers explored the relationships between plasma Apelin-13 and Apelin-36 concentrations and ventricular remodeling parameters(LVEF,LVEDD)and cardiac function parameter(NT-proBNP).Results ① There were no significant differences in the relevant predose test parameters between the two groups at baseline(all P>0.05).During the follow-up visits,plasma Apelin-13 and Apelin-36 concentrations were significantly higher in sacubitril/valsartan group than in valsartan group,both at week 13 and 25(all P<0.05).②At week 13,the improvement in LVEF was similar between the two groups(P>0.05).Patients in the sacubitril/valsartan group experienced better LVEF and LVEDD improvement at weeks 25 than those in the valsartan group(all P<0.05).Furthermore,at weeks 13 and 25,comparing the sacubitril/valsartan group to the valsartan group,the plasma NT-proBNP concentration was considerably lower(all P<0.05).The variations in LVEF,LVEDD,and NT-proBNP from baseline to week 13 were linked with the variations in plasma Apelin-13 and Apelin-36 concentrations(all P<0.05).③After half a year of follow-up,it is revealed that early usage of sacubitril/valsartan did not significantly lower the incidence of MACE,compared to valsartan(P>0.05).Conclusion Early sacubitril/valsartan use can considerably elevate plasma concentrations of Apelin-13 and Apelin-36 in patients with acute myocardial infarction complicated with cardiac insufficiency compared to valsartan treatment.It also can greatly reduce plasma NT-proBNP concentrations,effectively improve LVEF and LVEDD following myocardial infarction.The results of half-year follow-up showed that there was no significant difference in reducing MACE between the two groups.