Effects Of Entresto On Prognosis In Patients With Refractory Heart Failure

BackgroundHeart Failure?HF?is a set of clinical syndromes due to structural or functional abnormality of the heart,and its clinical manifestations are weakness,dyspnea and peripheral tissue edema.HF can lead to malignant arrhythmia?like ventricular tachycardia and ventricular fibrillation?,sudden cardiac arrest and sudden cardiac death,and it is a kind of disease which seriously threaten population health and put extra burdens on the household as well as the society in recent years^[1].Refractory heart failure?RHF?is a kind of HF which has a poor response to the optimized medical treatment,and it is the final stage of HF.Previous studies have suggested that,as a common kind of angiotensin converting enzyme inhibitors?ACEI?,perindopril can inhibit the synthesis of angiotensin II and aldosterone,and it has a significant therapeutic effect for HF,such as relieving the symptoms and improving cardiac function by reducing cardiac load as well as reversing cardiovascular remodeling^[2,3].Angiotensin receptor-neprilysin inhibitors?ARNI?is a new type of drugs for heart failure,and its representative drug is entresto,which can inhibit rennin-angiotensin-aldosterone system and neprilysin,therefore it can increase urine volume,dilate blood vessels,lower blood pressure and reversing myocardial remodeling^[4].There is little domestic research and trial on the entresto.This study contrasted the therapeutic effect of entresto and perindopril for CHF by analyze the clinical cases,and it aims to explore the therapeutic value and prognosis to provide a basis for domestic clinical treatment of refractory heart failure.ObjectiveTo provide RHF patients with entresto or perindopril,compare the cardiac function,adverse reactions and major adverse cardiovascular events in 6 months after discharge,and explore the therapeutic value of entresto for the treatment of refractory heart failure.Method1.This is a retrospective study,and a total of 180 patients with refractory heart failure admitted to the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University from January to September 2018 were selected,including 94males and 86 females,aged 31-89.All patients were randomly divided into entresto group?A group?and perindopril group?B group?.There were 90 patients were distributed into A group,and they were treated with conventional drugs?such as diuretics,digitalis,?-blockers and vasodilators?and entresto;other 90 patients were distributed into B group,and they were treated with conventional drugs and perindopril.On the first day of admission and 6 months after admission,serum NT-pro BNP,cTnT,BUN,Scr concentration were measured,while on the first day of admission and 6 months after admission,left ventricular end-diastolic dimension?LVEDD?and left ventricular ejection fraction?LVEF?were measured.The clinical symptoms,cardiac function,adverse reactions and in-hospital mortality were observed in the course of treatment.Follow-up and record of major adverse cardiovascular events in 6 months after discharge and readmission rate were finished.2.All data were analyzed with SPSS 21.0 statistical software to test whether each index obeyed the normal distribution.Measured data with normal distribution were expressed as mean±standard deviation?^-x±s?,and t-tests were used to compare two groups.Measured data with non-normal distribution were expressed as median(P₂₅,P₇₅),and rank-sum tests were used to compare two groups.Enumeration data were expressed as cases?%?,and?²-tests were used to compare two groups.Kaplan-Meier survival analysis was used to assess patients'survival at follow-up.P<0.05 was considered statistically significant.Result1.There was no statistically significant difference in age,gender,hypertension,hyperlipidemia,diabetes mellitus,the primary diseases and other kinds of drugs between the two groups?all P>0.05?.2.There was no statistically significant difference in serum NT-pro BNP and cTnT concentration between two groups on the first day after admission?P>0.05?.6months after discharge,serum NT-pro BNP concentration in A group was lower than that in B group,and the difference between the two groups was statistically significant?Z=-2.480,P<0.05?,while there was no statistically significant difference in serum cTnT concentration between the two groups?P>0.05?.3.There was no statistically significant difference in LVEDD and LVEF between the two groups on the first day after admission?P>0.05?.6 months after discharge,LVEDD in A group was lower than that in B group,and the difference between the two groups was statistically significant?t=2.323,P<0.05?,while LVEF in A group was higher than that in B group,and the difference between the two groups was statistically significant?t=-2.178,P<0.05?.4.There was no statistically significant difference in serum BUN and Scr concentration between the two groups on the first day after admission and 6 months after discharge?P>0.05?.5.All patients'clinical symptoms and cardiac functional grading?NYHA?were measured on the first day after admission:there were 23 patients of grade III and 67patients of grade IV in A group,while there were 20 patients of grade III and 70patients of grade IV in B group.There was no statistically significant difference between the two groups?P>0.05?.After 6 months of treatment,the total clinical effective rate in A group was higher than that in B group,and the difference between the two groups was statistically significant??²=8.578,P<0.05?.6.In the aspect of adverse reactions,the number of dry cough cases in A group was lower than that in B group,and the difference between the two groups was statistically significant??²=7.843,P<0.05?,while there was no statistically significant difference in hypotension,angioedema and hyperkalemia cases between the two groups?P>0.05?.The in-hospital mortality in A group was lower than that in B group,and the difference between the two groups was statistically significant??²=4.063,P<0.05?.7.In the aspect of major adverse cardiovascular events in 6 months after discharge,there was no statistically significant difference in cardiogenic shock cases between the two groups?P>0.05?;the heart failure relapse rate,the malignant arrhythmia rate and the sudden cardiac death rate in A group was lower than that in B group,and the difference between the two groups was statistically significant?P<0.05?.The readmission rate in A group was lower than that in B group,and the difference between the two groups was statistically significant?P<0.05?.8.Kaplan-Meier survival analysis showed that the survival prognosis of A group was significantly better than that of B group.Log-rank:P=0.032.ConclusionEntresto can relieve the symptoms,improve the cardiac function,reduce the mortality and readmission rate of the refractory heart failure patients more effectively than perindopril,a representative drug of ACEI.