Effect Of LCZ696 On Cardiac Function In Patients With Acute Myocardial Infarction Complicated With Heart Failure

Objective:To observe the effect of LCZ696(Saeubitril-Valsartan)on cardiac function and discss its therapeutic value on left ventricular remodeling and prognosis in patients with Acute myocardial infarction(AMI)complicated with Heart Failure(HF)-Methods:From June 2018 to D ecember 2019,43 patients with acute myocardial infarction complicated with heart failure were enrolled in the department of cardiology,affliated hospital of hebei university,including 15 females(34.9%)and 28 males 65.1%)whose average age was 63.42±9.30 years.Then randomly divided the people into the LCZ696 group(n=22)and the control group(n=21).The LCZ696 group:after admission to the hospital,we completed the relevant examination and excluded contraindications,then oral LCZ696.The control group:oral Benazepril.Basic information coll.ected afer admission:sex,age,previous history(history of smoking,diabets,hypertension,hyperlipidemia,stroke),Kilip class,whether or not to use recombinant human brain natriuretic peptide(rh-BNP),oral drug type(double antiplatelet,statins,loop diuretic,aldosterone receptor antagonist,beta-receptor antagonist),the number of coronary artery lesionss STEMI or NSTEMI,whether emergency PCI is performed,TIMI blood flow grades.Venous blood was collected in 24 hours after admission,the 4th and 12th week after discharge.Delected the level of kalium(K),creatine(Cr),N terminal brain natriuretic peptide precursor(NT-proBNP),aspartate aminotransferase(AST)and alanine aminotransferase(ALT);Measure d and recorded blood pressure(systolic blood pressure);Complete transthoracic echocardiography,recorded the value of the Left ventricular ejection fraction(LVEF),Left ventricular end-diastolic volume(LVEDV),Left ventricular end-systolic volume(LVESV),left ventricular end-diastolic anteroposterior diameter(LVEDD),left ventricular end-systolic dimension(LVESD).Outpatient follow-up for 12 weeks recorded the major adverse cardiovascular events(MACE)and the adversereactions.Result:1.Comparison of basic data betwen the two groups:There was no significant difference in dinical baseline data between the LCZ696 group and the control group(P>0.05),so the two groups are comparable.The clinical baseline data included sex,age,histomy of disease,Killip class,whether or not to use rh-BNP,oral drug type,the number of coronary artery lesions,STEMI or NSTEMI,whether emergency PCI is performed,TIMI blood flow grades and myocardial infarction markers.2.The level of NT-proBNP:Before treatm.ent,there was no difference between the two groups(P=0.868)At the 4th and the 12th week after dischage,the comparison of NT-proBNP in the two groups was significantly lower than that before treatment(P<0.001)and the difference between the two groups was statistically significant(P<0.001).The LCZ696 group was significantly lower than the control group.The difference of efficacy in different time was also statistically significant(F=886.957,P<0.001),indicting that the effect in the 12th week was better than that in the 4th week.3.Transthoracic echocardiography:Before treatment,there was no difference in LVEF,LVEDV,LVESV,LVEDD and LVESD between the groups(P=0.647,P=0.089.P=0.704,P=0.735.P=0.316).At the 4th week after dischage,the LVEF in the two groups was higher than that before treatment,and the LVEEDV,LVESV,LVEDD and LVESD were all lower than that before treatment,with statistically significant difference(P<0.001).but there was no statistically significant difference in LVEF,LVEDV,VESV,LVEEDD and LVESD between the two groups(P=0580,P=0.058,P=0.626,P=0.6.8).At the 12th week after dischage,the LVFF,LVEDV,LVESV,LVEDD and LVESD in the group were significantly improved compared with before treatment(P<0.001),and the comparison between the groups also stowed statistical differences(P=0.027,P<0.001,P<0.001,P=0.002,P<0.001)and the LCZ696 group was significantly better than the control group.4.SBP:Before treatment,there was no significant difference in systolic blood pressure between the LCZ696 group and the control group(P=0.930).At the 4th and the 12th week after dischage,the Systolic blond pressure in both groups was significantly lower than that before treatment(P<0.001),but there was no statistical difference between the two groups(P=0.509,P=0.673),and there was no significant change in systolic blood pressure at the 12th week compared with the 4th week(P=0.692).5.The level of Cr?K+?AST and ALT:Before treatment,there no difference between the two groups(P=0.694,P=0.783,P=0.988,P=0.798)At the 4th and the 12th week after dischage,the AST and ALT in both groups were significantly lower than before treatment(P<0.05)however,there was no significant change in AST and ALT at the 12th week and the 4th week(P=0.343,P=0.486),and there were no statistically significant difference in Cr,K+,AST and ALT between the two groups(P>0.05).6.Outpatient follow-up in 12 weeks:There was no difference in the incidence of adverse and MACE events between the LCZ696 group and the control group within 12 weeks(1(4.5%)vs 2(9.8%),P?0.05).Conclusion:In patients with acute myocardial infarction complicated with heart failure,LCZ696 can effectively inhibit cardiac remodeling,significantly improve cardiac function,and do not increase the incidence of adverse reactions and recent MACE events compared with Benazepril.