Effect Of Sacubitril/valsartan Combined With Aerobic Exercise On Cardiopulmonary Function In Heart Failure Patients With Preserved Ejection Fraction

Background:Chronic heart failure is a condition where cardiac dysfunction and myocardial damage caused by various factors lead to continuous heart failure.It is characterized by high hospitalization and fatality rates,which severely impact the quality of life and health of patients.There are three types of chronic heart failure based on left ventricular ejection fraction:heart failure with reduced ejection fraction,heart failure with intermediate ejection fraction,and heart failure with preserved ejection fraction.The incidence of heart failure with preserved ejection fraction is increasing annually as the standard of living and life expectancy improve.Cardiac rehabilitation has become a popular topic worldwide for patients with chronic heart failure,and it has shown promising results in enhancing exercise endurance,improving endothelial function,and inhibiting left ventricular remodeling.Sacubitril/Valsartan is an angiotensin receptor-enkephalase dual blocker that has been proven to be beneficial for patients with heart failure with reduced ejection fraction.Based on current evidence,Sacubitril/Valsartan is also beneficial for patients with heart failure with preserved ejection fraction,but further clinical studies are necessary.Objective:The aim of this study was to investigate the effects of Sacubitril/Valsartan assisted aerobic exercise therapy on cardiopulmonary function in patients with heart failure with preserved left ventricular ejection fraction.Method:From March 2021 to June 2022,a total of 90 patients diagnosed with heart failure with preserved ejection fraction were randomly assigned to three groups,with 30 patients in each group,at the Department of Cardiovascular of the First Affiliated Hospital of Hebei North University.The control group received standardized anti-heart failure treatment.In the ARNI group,the angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme receptor inhibitors used in the standard anti-heart failure treatment regimen were replaced with Sacubitril-Valsartan;The drug treatment plan of the combined group was consistent with that of the ARNI treatment group.Meanwhile,aerobic exercise plan was developed for cardiac rehabilitation according to the metabolic equivalent obtained from cardiopulmonary exercise test.The three groups were treated continuously for 3 months,and the changes of cardiopulmonary function before and after treatment were compared between the three groups.Results:1.The NT-pro BNP levels and E/e’values of all three treatment groups improved significantly compared to before treatment.The levels of LVEDD of the ARNI treatment group and the combined treatment group also showed significant improvement compared to before treatment.2.In the comparison between the different heart function groups after treatment,the NT-pro BNP levels of the ARNI treatment group and the combined treatment group improved more significantly than the control group.The LVEDD levels and E/e’values of the combined treatment group showed more significant improvement than the other two groups.3.The AT values of ARNI treatment group and combined treatment group showed a significant increase compared to before treatment,with better improvement in peak VO₂ and peak VO₂/kg for the ARNI treatment group and the combined treatment group.4.In the comparison between the different lung function groups after treatment,the AT values,peak VO₂,and peak VO₂/kg of the ARNI treatment group and the combined treatment group showed significant improvement compared to the control group,with better improvement observed in the combined treatment group.Conclusion:1.The use of Sacubitril/Valsartan in patients with heart failure with preserved ejection fraction is significantly beneficial for improving heart function.2.The combination of Sacubitril/Valsartan and aerobic exercise has been shown to have a significant positive impact on heart failure patients with preserved ejection fraction.This treatment approach leads to significant improvements in both cardiac and pulmonary function.