Efficacy Analysis Of Sacubitril/Valsartan In The Treatment Of Chronic Heart Failure Caused By Ischemic Cardiomyopathy And Dilated Cardiomyopathy

ObjectiveThe changes of cardiac systolic function,myocardial remodeling,heart failure efficacy indexes,clinical efficacy changes,the incidence of adverse reactions and adverse events were compared between the two groups before and after Sacubitril/valsartan treatment.The objective is to explore the practical efficacy and safety of Sacubitril/valsartan in patients with chronic heart failure caused by ischemic cardiomyopathy and dilated cardiomyopathy.MethodsThis study was a prospective study.Patients with chronic heart failure who were hospitalized in the Department of Cardiology of Ordos Central Hospital from March 2019 to September 2020 were selected as the research subjects.Patients who meeting the inclusion criteria were divided into two groups according to the etiology of chronic heart failure.One group was the ischemic cardiomyopathy(ICM)group.A total of 30 patients(including 23 males and 7 females)were enrolled.The mean age of ICM patients was 69.60±10.39 years old.The other group was dilated cardiomyopathy(DCM).A total of 30 patients(including 25 males and 5 females)were enrolled.The average age of the DCM group was 64.57±10.27 years old.All patients were conform to the New York Heart Association heart function classⅡ～Ⅳ.Two groups of patients were accepted routine treatment of heart failure.Drug therapy includes beta blockers,and aldosterone receptor antagonist,digitalis preparations and diuretics,etc.Adjust the medicine according to the symptoms.Replace ACEI/ARB in the anti-heart failure regimen with Sacubitril/valsartan.The starting dose of Sacubitril/valsartan is25 mg bid.According to the patient’s tolerance to Sacubitril/valsartan and the changes in blood pressure,the drug dose was gradually increased to the target dose of 200 mg bid and maintained.If the drug had a significant effect on blood pressure,the dose would be decreased.When patients were enrolled,baseline data such as smoking history,hypertension,diabetes,hyperlipidemia and other diseases,as well as specific medication were recorded in detail in the two groups.All patients were followed up by telephone and outpatient follow-up after 6 months of continuous treatment.Comparison was made between ICM group and DCM group in the improvement of cardiac function grading,the degree of improvement of left ventricular ejection fraction,the reduction of left ventricular end-diastolic diameter,and the decrease of NT-proBNP before and after Sacubitril/valsartan treatment.To evaluate the efficacy of Sacubitril/valsartan in the treatment of heart failure caused by two different etiologies,we analyzed whether there were differences in the changes between the two groups.At the same time,we investigated the occurrence of serious adverse reactions and adverse events in patients of two groups during the treatment of Sacubitril/valsartan.Results1.There was no statistical difference between ICM group and DCM group in general information such as age,gender,cardiac function grade,complicated diseases,medication.There was comparability between the two groups.2.After 6 months of treatment with Sacubitril/valsartan,the left ventricular ejection fraction increased in both ICM and DCM groups,and there was no difference between the two groups.3.The left ventricular end-diastolic diameter of the ICM group and the DCM group decreased after 6 months of treatment with Sacubitril/valsartan,and there was no difference between the two groups.4.The level of NT-proBNP in ICM group and DCM group decreased significantly after 6months of treatment with Sacubitril/valsartan,and there was no difference between the two groups.5.There were no significant changes in urea,creatinine and serum potassium in two groups before and after treatment.This suggests that Sacubitril/valsartan does not cause significant renal damage and hyperkalemia.6.After treatment with Sacubitril/valsartan,there was a modest reduction in systolic blood pressure in both groups,but there was no serious uncorrected hypotension.7.The effective rate of Sacubitril/valsartan treatment was higher in the two groups.The occurrence of adverse reactions and adverse events was less.Conclusion1.After 6 months of treatment with Sacubitril/valsartann,clinical symptoms and cardiac function in patients with heart failure caused by ICM and DCM were improved,ventricular remodeling was delayed,NT-proBNP levels were reduced,and systolic blood pressure was reduced.2.The efficacy was consistent between the two groups.3.There was no difference in adverse reactions and events between the two groups after6 months of Sacubitril/valsartan treatment.The safety was the same.