Efficacy Of Sacubitril/valsartan On Pulmonary Hypertension Associated With Chronic Left Heart Failure

BackgroundPulmonary hypertension is a common complication of left heart disease,especially left heart failure,there was no efficacious specific agents on pulmonary hypertension associated with left heart failure.Sacubitril/valsartan is a new drug acting as a neprilysin inhibitor and as an angiotensin receptor blocker,which has progressed to be one of the most promising medication since its approval for chronic heart failure with reduced ejection fraction.Studies have shown that valsartan can effectively reduce pulmonary artery systolic blood pressure in patients with pulmonary hypertension,however,so far the clinical effect of sacubitril/valsartan on pulmonary hypertension associated with left heart failure is not clear.50 cases were reported in this study to provide a new idea for the treatment of pulmonary hypertension associated with chronic heart failure.ObjectiveTo evaluate the effect of sacubitril/valsartan on pulmonary hypertension associated with chronic heart failure.MethodsA total of 50 patients with pulmonary hypertension associated with left heart failure in the First Affiliated Hospital of Zhengzhou University from October 2017 to Ocboter 2018 were randomly divided into the control group(n=25 cases)and the observation group(n=25 cases).Observation group was treated with sacubitril/valsartan by 50 mg twice daily and control group with valsartan by 80 mg daily on the basis of routine treatment,while sacubitril/valsartan was dosed to the target recommended(200 mg twice daily)or maximum tolerated.SPSS 21.0 was used to compare the differences of N-terminal pro-brain natriuretic peptide(NT-pro BNP),left ventricular ejection fraction(LVEF),6-minute walking distance(6MWD),pulmonary artery systolic blood pressure(PASP),left ventricular end-diastolic diameter(LVEDd),right ventricular end-diastolic diameter(RVEDd)and systolic blood pressure(SBP)between the two groups before and after treatment by t test,paired-t test and?~2 test.Results1.Before treatment,there were no significant differences of 6WMD,LVEF,NT-proBNP,PASP,LVEDd,RVEDd and SBP between two groups(P>0.05).2.After 12 weeks of treatment,in both of the two groups,6WMD and LVEF were increased,NT-proBNP,PASP,LVEDd,RVEDd and SBP were reduced,and all the differences were statistically significant(P<0.01);furthermore,the 6WMD,LVEF,NT-proBNP,PASP,LVEDd,RVEDd and SBP of the observation group were significantly improved compared with the control group(P<0.01).3.There were no significant differences in drug adverse reactions and adverse cardiac events between the two groups after treatment(P>0.05).Conclusion:Compared to valsartan,sacubitril/valsartan can more effectively reduce the pulmonary artery systolic pressure,improve left ventricular ejection fraction,reverse cardiac structure,and increase the 6-minute walking distance of patients with chronic left heart failure,with relativey high safe.