| ObjectiveTo investigate the clinical efficacy of Sacubitril/valsartan in the treatment of patients with chronic heart failure caused by different etiologies after treatment.Compare the clinical efficacy of different etiological diagnosis and cardiac function classification of patients with heart failure after the use of conventional treatment dose of Sacubitril/valsartan.To provide more data and guide clinical practice for the new heart failure drugs Sacubitril/valsartan in the treatment of chronic heart failure.Methods1.154 patients with chronic heart failure with ejection fraction(LVEF)? 40%)admitted to our hospital from February 2018 to August 2019 were selected as the studyobjects.And general data was collected: imaging data(echocardiography,chest X-ray/chest CT,etc.),and relevant laboratory examination results(NT-proBNP,etc.)confirmed the structural or functional abnormalities of the heart.2.According to different etiologies of chronic heart failure patients are divided into(structural heart disease group,ischemic heart disease group,hypertensive heart disease group and dilated cardiomyopathy group).According to different cardiac function(NYHA classification: cardiac function class II,III,IV)group.Patients with heart each chamber: right about room size(RAd),right ventricular diameter(RVd),left after the front diameter(LAd),Left ventricular end systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)size and left ventricular ejection fraction(LVEF),and ensure the there was no statistically significant difference among the groups of groups before treatment.3.Using an open-access study,all patients were given conventional anti-heart failure treatment regiments,including general treatment: lifestyle management(patient health education,weight and diet management),rest and aerobic exercise according to heart function,treatment of causes and elimination of incentives;Drug treatment: ?receptor antagonism blockers,spironolactone,RAAS inhibitors,and use diuresis,vasodilators,cardiotonic according to the symptoms and sings,such as symptomatic treatment drugs,and replaced ACEI/ARB of the conventional treatment of heart failure resistance with Sacubitril/valsartan(Novartis Pharma Schweiz AG,H20170362,50 mg,100 mg/tablet),oral,according to individual patients condition(such as blood pressure,blood potassium,serum creatinine)adjust doses(50 mg to 200 mg/day)to the maximum tolerated dose,regular treatment for 3 months.ACEI must be discontinued for36 h before treatment.Eventually observing the indicators and evaluating the efficacy.4.Telephone and outpatient follow-up were conducted regularly,and the patients were examined for echocardiography after 3 months of standardized treatment,to observe the effective rate of treatment,the incidence of end-point cardiovascular events,and the changes of cardiac Chambers before and after treatment.Results1.The overall effective rate of Sacubitril/valsartan in the treatment of patients with chronic heart failure((significant + effective)cases/total cases ×100%)was87.66%,and there was no significant difference in the effective rate among groups with different heart function grades and groups with different causes of heart failure(P>0.05).2.Before Sacubitril/valsartan treatment,patients were grouped according to different cardiac function grades and different etiology,and there were no statistically significant differences in the size of each cardiac chamber and LVEF among the groups(P> 0.05).3.After treatment with Sacubitril/valsartan,patients were grouped according to different cardiac function grades and different etiology,and there were no statistically significant differences in the size of each cardiac chamber and LVEF between the groups(P> 0.05).4.According to the classification of different cardiac functions,echocardiography results showed no significant difference in the left and right atrial diameters,right ventricular anterior-posterior diameters and left atrial anterior-posterior diameters after standardized treatment(P>0.05).The echocardiography results showed that the left ventricular end systolic diameter and the left ventricular endomastolic diameter decreased significantly and the ejection fraction of the left ventricular increased significantly after treatment,with statistically significant differences(P<0.05).5.According to the classification of different causes of heart failure,echocardiography results showed no significant difference in right atrial diameter,right ventricular anteroposterior diameter,and left atrial anteroposterior diameter after standardized treatment(P>0.05).The echocardiography results showed that leftventricular end systolic diameter and the left ventricular endomastolic diameter decreased significantly and the ejection fraction of the left ventricular increased significantly after treatment,with statistically significant differences(P<0.05).6.The standardized treatment of ACEI/ARB in conventional "jinsanlian" therapy was replaced with Sacubitril/valsartan for 3 months.During the follow-up,the incidence of major adverse cardiovascular events was 10.39%(16/154)(5 deaths,10 readurances for heart failure aggravation,1 abandon treatment).Conclusion1.For patients with chronic heart failure,the effective rate(87.66%)of standardized Sacubitril/valsartan treatment was lower than that of conventional "golden triangle"(beta blockers,ACEI/ARB,spironolactone)(90.7%),and the incidence of major adverse cardiovascular events(10.39%)was lower than that of conventional treatment,suggesting that it has a better effect on patients with chronic heart failure.2.The echocardiography showed that there was a decreasing trend in the left and right atrial diameters,right ventricular anteroposterior diameters and left anterior and posterior diameters after treatment,but the difference was not statistically significant,which may be due to the different sensitivity of each cardiac chamber to reverse myocardial remodeling,or may be related to the insufficient treatment cycle and short follow-up time.3.Comparison of the results of echocardiography in patients with different etiology and cardiac function grade after treatment showed that the left ventricular end systolic diameter and the left ventricular end-diastolic diameter were reduced and the left ventricular ejection fraction was significantly increased,suggesting that Sacubitril/valsartan could significantly improve ventricular remodeling and left ventricular myocardial maybe more obvious.Sacubitril/valsartan also significantly improved cardiac function and ejection fraction.4.Sacubitril/valsartan has good effect on heart failure caused by different causes,and has similar clinical effects of treatment to patients with different heart function classification(NYHA ? ~ ? level). |
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