Effect Of Sacubitril Valsartan On Left Ventricular Remodeling In Patients With Acute Myocardial Infarction

Objective: This study focused on the related indexes of left ventricular remodeling in patients with acute myocardial infarction,and compared the intervention effect of sacubitril valsartan and benazepril on left ventricular remodeling to guide clinical treatment.Method: From September 2018 to January 2019,60 patients with acute ST segment elevation myocardial infarction who were treated in the second hospital of Tianjin Medical University were all treated with PCI.According to the later treatment drugs,the patients were divided into two groups: the experimental group(using sacubitril valsartan)and the control group(using benazepril).color doppler echocardiography was performed after myocardial infarction for 1 month and 3 months respectively,and "gender,NT Pro BNP,interventricular septal thickness,septal motion amplitude,left ventricular end diastolic diameter,left ventricular end systolic diameter,posterior wall thickness,posterior wall motion amplitude,LVEF,height,weight,body surface area,left ventricular weight,left ventricular weight index" and other indexes were collected.In order to evaluate the influencing factors in the process of left ventricular remodeling,binary multivariate logistic regression analysis was carried out for the indicators with statistical differences in the conclusions of the above control study,and the or value was calculated.Sub group analysis was carried out,and the samples were divided into four sub groups according to sex,age,initial ejection fraction and other indicators.Result:1.Comparison of clinical data: there is no statistical difference between the two groups in terms of gender,height,weight,body surface area and other basic data,which can be compared.There was no significant difference between the two groups in the clinical data of NT Pro BNP,interventricular septal thickness,septal motion amplitude,left ventricular end diastolic diameter,left ventricular end systolic diameter,posterior wall thickness,posterior wall motion amplitude,LVEF,left ventricular weight,left ventricular weight index and so on.2.Comparison of clinical data after 1 month of treatment: one month after treatment with benazepril or sacubitril valsartan,only the left ventricular end systolic diameter had statistical difference between the two groups(P < 0.05),and the other indexes had no statistical difference.3.Comparison of clinical data after 3 months of treatment: three months after treatment with benazepril or sacubitril valsartan,there were statistically significant differences between the two groups in the indexes related to left ventricular remodeling,such as the range of septal motion,the end diastolic diameter of left ventricle,the end systolic diameter of left ventricle,the range of posterior wall motion and LVEF(P < 0.05).There was no statistical difference in the other indexes.4.The results of multivariate logistic analysis showed that the index of left ventricular end systolic diameter was statistically significant or: 0.006(95% CI: 0.733-0.981)5.Among the patients of different genders,sacubitril valsartan is better than benazepril in the treatment of left ventricular remodeling.The treatment effect of male patients is more obvious than that of female patients.6.For patients of different ages and younger patients,the treatment of sacubitril valsartan is better than benazepril.It is related to the myocardial reserve ability of young patients.It can also be seen that the related indexes of the elderly patients are better than those of the benazepril treatment group.Therefore,it can be concluded that the effect of the treatment of left ventricular remodeling of the patients with acute myocardial infarction in the whole age group is better than that of benazepril,and the benefit is greater than that of the young patients(age < 65 years old).7.Most of the patients with acute myocardial infarction whose LVEF is less than or equal to 50% are anterior wall myocardial infarction,with large infarct area and serious myocardial damage.The cardiac function and structure were obviously abnormal.In the treatment,sacubitril valsartan was better than benazepril.Most of the patients with LVEF greater than 50% were inferior myocardial infarction.The left ventricular function and structure of the patients were not seriously damaged,and there was no evidence of cardiac insufficiency.After treatment with two drugs,there was no significant abnormality in the left ventricular remodeling related indexes.Conclusion:1.There was no significant difference in the effect of short-term treatment of sacubitril valsartan and benazepril on left ventricular remodeling in patients with acute ST segment elevation myocardial infarction.2.Compared with benazepril,the effect of long-term treatment of sacubitril valsartan on left ventricular remodeling in patients with ST segment elevation acute myocardial infarction is better.3.Among the patients of different genders,sacubitril valsartan is better than benazepril in the treatment of left ventricular remodeling.The treatment effect of male patients is more obvious than that of female patients.4.Among the patients of different ages,the effect of sacubitril valsartan is better than benazepril in the treatment of left ventricular remodeling in patients with acute myocardial infarction of all ages,and the benefit is greater than that of younger patients(age < 65 years).5.In patients with different states,patients with LVEF ≤ 50% showed better therapeutic effect than benazepril.In the patients with LVEF > 50%,the therapeutic effect of two kinds of drugs is similar.