| Background:Early ventricular remodeling usually occurs within 24 to 72 h after Acute myocardial infarction(AMI).The infarcted area is enlarged,the ventricular lumen is dilated,the myocyte is necrotic,and the myocardial is arrhythmias.The rate of asymptomatic left ventricular systolic dysfunction after AMI is as high as 30%～60%.Even though patients with myocardial infarction had received Percuteneous coronary intervention(PCI),the incidence of Heart Failure(HF)after myocardial infarction still doubled.Therefore,ventricular remodeling after AMI is an independent predictor of HF and one of the main factors affecting the prognosis of patients.The risk of ventricular remodeling in Acute anterior wall myocardial infarction(AAMI)was 1.9-fold higher than that in other sites.Sacubitril-valsartan(LCZ696),as a novel drug,can inhibit both enkephalase and Angiotensin typel receptor(AT1R).By inhibiting the renin-angiotensinaldosterone-system(RAAS)and regulating the natriuretic peptide system,myocardial remodeling and sympathetic nervous system activity were inhibited.At present,the use of LCZ696 in patients with heart failure has been unanimously approved in studies.However,in patients with AAMI complicated with mild cardiac insufficiency,there is still insufficient evidence on whether the effect of early application of LCZ696 is better than that of traditional ACEI/ARB drugs on early ventricular remodeling.Therefore,in this study,the patients with Killip grade of I-B stage after AAMI were selected as the research subjects,and compared with benazepril hydrochloride,the protective effect of early application of LCZ696 on ventricular remodeling in patients was investigated.Objective:To objective To observe the effect of early application of lcz696 on ventricular remodeling in patients with acute anterior myocardial infarction(AMI),and to provide reference for AAMI combined with Killip grade Ⅰ-Ⅱ left ventricular remodeling and evaluation of specific recovery after treatment.Methods:In this study,60 patients with acute anterior myocardial infarction(AMI)and Killip grade Ⅰ-Ⅱ admitted to the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from September 2018 to September 2019 were collected,including 34 males(56.67%)and 26 females(43.33%),with an average age of 62.15 years ± 52 years old.They were randomly divided into experimental grop(30 cases)and control group(30 cases).Patients on the basis of routine treatments,benazepril hydrochloride(control group)and Sacubitril/Valsartan(LCZ696 group)were added respectively.After entering the hospital,collect basic data of patients:gender,age,BMI,basic history(including hypertension,diabetes,hyperlipidemia,etc.),Killip level,oral medication type(such as Aspirin Enteric-coated Tablets,Clopidogrel Bisulfate Tablets,Isosorbide Mononitrate Sustained Release Tablets,Metoprolol Succinate Sustained-release Tablets,Atorvastatin Calcium Tablets,etc.),whether the onset of emergency PCI within 24 hours.Thrombolysis in myocardial infarction(TIMI)blood flow classification.SPSS 21.0 was used to compare the differences of the level of kalium(K),creatine(Cr),N terminal brain natriuretic peptide precursor(NT-proBNP),systolic blood pressure,the value of the Left ventricular ejection fraction(LVEF),left ventricular end-diastolic anteroposterior diameter(LVEDD),left ventricular end-systolic diamension(LVESD),the heart rate variability.6-minute walking experiment(6MWT)between the two groups before and after the first month,6th month treatment by t test,paired-t test and x2test.All patients were followed up for half a year,including adverse cardiovascular events(MACE)and adverse reactions.Results:1.General clinical data:before diagnosis and treatment,gender,age,BMI,past history,killip grade,type of oral medication,ST segment elevation myocardial infarction(STEMI)or non ST segment elevation myocardial infarction(NSTEMI),emergency PCI,TIMI blood flow evaluation,clinical data of the two groups were compared There was no significant difference in myocardial infarction markers(P>0.05).2.NT proBNP comparison:before diagnosis and treatment,there was no difference between the two groups(P>0.05).However,at 1 month and 6 months after discharge,NT proBNP in the two groups was significantly lower than that before treatment(P<0.05),and there was a significant difference between the two groups(P<0.05).The results showed that the indicators of diagnosis and treatment in 6 months were significantly better than those in 1 month..3.LVEF LVEDD and LVESD:Before diagnosis and treatment,there was no difference in LVEF,LVEDd and LVESD between the observation group and the control group(P>0.05,P>0.05,P>0.05).In the two periods of 1 and 6 months after discharge,the LVEF indexes of the two groups were improved compared with those before diagnosis and treatment(P<0.05),the other two groups were reduced,and the difference was significant(P<0.001,P<0.001),and the LVEF of the observation group was higher than that of the control group(P<0.05),LVEDd(P<0.05),LVESD(P<0.05)were smaller.4.The heart rate variability:Before treatment,there was no difference in the heart rate variability between the groups(P>0.05.At the first month and 6th month after dischage,the heart rate variability in the two groups was higher than that before treatment(P<0.05),and there was statistically significant difference the heart rate variability between the LCZ696 group and the control group(P>0.05).5.The level of Cr,K:Before treatment,there was no difference between the two groups(P=0.584 P=0.683).There were no statistically significant differences in were no statistically significant differences in Cr,K+between the LCZ696 group and the control group(P>0.05).6.Outpatient follow-up in 12 weeks:There was no significant difference in mace events and side effects between the two groups within 6 months(7(23.3%))vs 5(16.7%),P=0.065).Conclusion:Compared with benazepril hydrochloride,sacubatro and valsartan,benazepril hydrochloride,sacubatro and valsartan can effectively inhibit ventricular remodeling,significantly improve cardiac function,and do not increase the incidence of adverse cardiac events and drug reactions. |
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