| Objective:The purpose of this study is to observe the changes of the echocardiographic indexs,N-terminal pro-brainnatriuretic peptide(NT-proBNP),renal function,serum potassium,the score of Kansas City Cardiomyopathy Questionnaire(KCCQ),as well as recent clinical adverse cardiovascular events and drug-related adverse reactions in patients with heart failure due to ischemic Cardiomyopathy aftertaking Sacubitril/Valsartan or Perindopril for 3 and 6 months,so as to provide more evidence-based medicine for the clinical treatment of Heart Failure due to Ischemic CardiomyopathyMethods:A total of 130 patients diagnosed heart failure due to ischemic cardiomyopathy in inpatient or outpatient in the department of cardiovascular medicine of the Affiliated Hospital of North Sichuan Medical College from June 2018 to June 2020 were selected for this study.Patients who met the inclusion criteria were divided into Sacubitril/Valsartan group(group A)and Perindopril group(group B)by random number method,which were treated withSacubitril/Valsartan or Perindopril on the basis of standard heart failure medication for 6 months.Then the general clinical data of the patients,such as gender,age,BMI,smoking history,previous history and combination medication,were collected.Then we observed the changes of echocardiographic indexs,NT-proBNP,renal function,serum potassium and KCCQ score and other examination indexes in two groups of patients after 3 and 6 months of treatment.Recent clinical adverse cardiovascular events and drug-related adverse reactions were also recorded.All the results were analyzed by SPSS21.0 software.Results:1.There was no statistical difference between the two groups in gender,age,BMI,SBP,DBP,smoking history,administration mode,previous history,drug combination,classification of cardiac function(NYHA)and the type of heart failure(P>0.05).2.There was no statistical difference in the levels of uric acid(UA),serum potassium(K+),estimated glomerular filtration rate(eGFR)and blood urea nitrogen(BUN)between the two groups before and after the treatment(P>0.05).After treatment,the level of Cystatin C(CysC)in both two groups decreased compared with before treatment,and the difference was statistical(P<0.05),but there was no statistical difference between A and B groups(P>0.05).At the same time,the level of Serum creatinine(Scr)in group A was significantly lower than that before treatment,the difference was statistical(P<0.05);But the level of Scr in group B was not significantly lower than that before treatment,the difference was not statistical(P>0.05);there was no statistical difference between group A and B(P>0.05).3.There was no statistical difference in NT-proBNP between the two groups before treatment(P>0.05),and then NT-proBNP decreased in both two groups after treatment,the difference was statistical(P<0.05).There was no statistical difference between group A and group B after 3 months of treatment(P>0.05),but the decrease of NT-proBNP in group A was more obvious than that in group B after 6 months of treatment,the difference was statistical(P<0.05).4.In two groups of patients,the different of Left ventricular ejection fraction(LVEF),Left Ventricular Posterior Wall Thickness(LVPWT),interventricular septum Thickness(IVST),left atrial diameter(LA),left ventricular end-diastolic diameter(LVEDd)and Left ventricular mass index(LVMI)was no statistical difference before treatment.After treatment,LVEF values of patients in the three subgroups(HFrEF、HFmrEF、HFpEF subgroups)were significantly increased compared with before treatment,the difference was statistically significant(P<0.05),but there was no statistical difference between the two groups(P>0.05).Other indexes were significantly lower after treatment than before treatment,and the difference was statistically significant(P<0.05),except LVPWT in the HFmrEF subgroup of group A and IVST in the HFmrEF subgroup of group A and B(P>0.05).IVST of HFpEF subgroup of group A was significantly lower than that of group B after treatment for six months,the difference was statistical(P<0.05),and there was no statistical difference in the remaining indicators between group A and B(P>0.05).5.There was no statistical difference in KCCQ scores between the two groups before treatment(P>0.05);And after treatment,KCCQ scores in both groups were significantly higher than before treatment with statistical difference(P<0.05).The KCCQ scores of group A after 3 and 6 months of treatment was significantly higher than that of group B with statistical significance(P<0.05).6.There was no statistical difference in the clinicaladverse cardiovascular events between the two groups(P>0.05).7.In group A,the initial dose of Sacubitril/Valsartan was 66.31±25.79mg per day,177.13±63.83mg per day of Sacubitril/Valsartan after 3 months,197.13±59.81mg per dayof Sacubitril/Valsartan were finally given after 6 months.In group B,the initial dose of Perindopril was 4.54±1.09mg per day,5.87±2.03mg per day of Perindopril after 3 months,the final dose of Perindopril was 6.62±1.94mg per day after 6 months.Conclusion:1.In patients with heart failure due to ischemic cardiomyopathy,both Sacubitril/Valsartan and Perindopril can reverse left ventricular remodeling and improve cardiac function,and in the HFpEF subgroup,Sacubitril/Valsartan improved left ventricular remodeling slightly better than Perindopril after 6 months of treatment.2.For patients with heart failure due to ischemic cardiomyopathy,Sacubitril/Valsartan is superior to Perindopril in reducing NT-proBNP,improving renal function and improving patients’ quality of life.3.The incidence of drug-related adverse reactions and clinical adverse events of the two drugs are low,and the safety of the two drugs is great. |
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