Effect Of Sacubitril/valsartan On Myocardial Energy Expenditure And Cardiac Function In Patients With Heart Failure

Objective: Heart failure is the terminal stage of many cardiovascular diseases,which seriously threatens human health.Abnormal myocardial energy metabolism plays an important role in heart failure.Detecting the level of myocardial energy metabolism is helpful to evaluate the condition of patients with heart failure.At the same time,myocardial energy metabolism may also become a new target for the treatment of heart failure.Previous studies have found that angiotensin converting enzyme inhibitors(ACEI)and angiotensin Ⅱ receptor blockers(ARB)slow down the myocardial remodeling in patients with heart failure and improve the prognosis of patients with heart failure.However,the efficacy of ACEI/ARB is not satisfactory enough and the mortality of heart failure remains high.As the world’s first angiotensin receptor-neprilysin inhibitor,sacubitril/valsartan significantly reduces the hospitalization and mortality of heart failure,improves quality of life,and is more effective than ACEI and ARB in patients with heart failure with reduced ejection fraction.However,studies on the effects of sacubitril/valsartan on myocardial energy metabolism in patients with heart failure are still lacking.In this study,the effect of sacubitril/valsartan on myocardial energy expenditure(MEE)in patients with heart failure was evaluated in the treatment group of renin-angiotensin-aldosterone system(RAAS)inhibitors,and the correlation of cardiac energy metabolism with cardiac contractility,diastolic function,ventricular structure and pulmonary arterial pressure was analyzed.Methods:140 patients with heart failure with LVEF<50%who were hospitalized in the cardiology department of the 9th people’s hospital affiliated to Shanghai Jiao Tong University from January 2019 to September 2019 were selected as the study subjects,of which 94 were male patients with an average age of 66 years.A series of general conditions such as age,sex,blood pressure and anamnesis were recorded after admission.The biochemical indexes of blood routine examination,CRP,BNP,liver function and kidney function were taken after admission.All the subjects completed echocardiography within 3 days after admission,measuring left ventricular internal dimension diastole(LVIDd),left ventricular internal dimension systole(LVIDs),the ratio of early transmitral flow velocity to the ratio of later transmitral flow velocity(E/A),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),and myocardial energy expenditure(MEE)level.At the 6 months after discharge from the hospital follow-up to review the patient’s echocardiography.The patients were grouped according to their treatment drugs during hospitalization,including 39 cases in ACEI treatment group,30 cases in ARB treatment group and 71 cases in sacubitril/valsartan treatment group.Results: There was no significant difference in basic characteristics,anamnesis and blood biochemical test index in each group.There was no significant difference between the two groups in the baseline indexes of echocardiography.ACEI,ARB and sacubitril/valsartan all increased LVEF in patients with heart failure while lowering MEE,LVIDd and LVIDs.None of them had significant effects on E/A.Compared with ACEI/ARB,the improvement of LVEF and MEE was more significant in sacubitril/valsartan group.Sacubitril/valsartan reduced PASP in patients with heart failure,while ACEI/ARB had no significant effect on PASP.There was a negative correlation between MEE and LVEF.MEE was positively correlated with LVIDd,LVIDs and E/A,while there was no significant correlation between MEE and PASP.Conclusion: For patients with heart failure,ACEI,ARB and sacubitril/valsartan improved ventricular ejection function,reduced myocardial energy expenditure and reversed myocardial remodeling to varying degrees.The therapeutic effect of sacubitril/valsartan was better than that of ACEI/ARB in all respects.However,neither ACEI/ARB nor sacubitril/valsartan improved ventricular function significantly,suggesting that both RAAS inhibitors and sacubitril/valsartan mainly improve the symptoms of heart failure in patients by enhancing ventricular systolic function,which is not significantly helpful for ventricular diastolic function.Myocardial energy expenditure is closely related to left ventricular systolic function.