| Objective To investigate the effect of reduced left ventricular ejection fraction on heart failure with Sacubitril/valsartan increasing to target dose.Soluble growth stimulation expressed gene 2(s ST2)and inflammatory factors in HFr EF patients.Methods Patients with acute HFr EF who were hospitalized in The Affiliated Hospital of Qingdao University from March 1,2020 to June 28,2021 were enrolled.Sacubitril/valsartan treatment(50mg twice a day)was initiated as early as possible in the hospital,and gradually increased to the target dose of 200 mg twice a day according to the changes of patients’ hemodynamics.Follow-up for 12 weeks was conducted.Time of increment to target dose was recorded.The 12-week increments to the target dose were set as the standard group,and the non-increments to the target dose were set as the non-standard group.SST2 and inflammatory factors in the two groups were compared,including: pro-inflammatory factors[Interleukin(IL)-1β,IL-6,TNF-α];Anti-inflamma Left ventricular ejection fractiontory factor(IL-10)and the changes in Left atrium anterior-posterie(LA)and Left ventricular end diastolic dimension measured by echocardiography were observed(LVDd)and(LVEF);At the same time,s ST2 and inflammatory factors in the standard group were compared at different time of standard.The differences of safety indexes,rehospitalization due to heart failure and all-cause death within 12 weeks after discharge were compared between the two groups.Results A total of 133 patients with acute HFr EF were enrolled in this study,and 10 patients were lost to follow-up,a total of 123 patients,including 72 patients(58.54%)in the standard group and 51 patients(41.46%)in the non-standard group.Age range: 50-75(65.79 ±6.50)years;There were 86 males(69.92%)and 37 females(30.08%).There were no significant differences in age,gender,heart failure etiology,complications,clinical medication,blood biochemistry,s ST2,inflammatory factors and echocardiography before treatment between 2 groups(P>0.05).Compared with before treatment,difference value in s ST2 and inflammatory factors within and between the 2 groups after treatment were statistically significant(P<0.05).SST2 and inflammatory factors difference value were correlated with LVDd and LVEF difference value(P<0.05).SST2,inflammatory factors and echocardiographic measurements of patients in the standard group had statistical significance before and after treatment(P<0.05),and the difference showed a downward trend.Secondary indicators: Rehospitalization for heart failure(41.18%)and all-cause death(7.84%)within 12 weeks after discharge were compared between the two groups,and the differences were statistically significant(P<0.05).Safety indicators: There was no statistically significant difference in hyperkalemia and symptomatic hypotension between the two groups of patients with acute HFr EF(P>0.05),and no adverse events such as renal deterioration and angioedema occurred during follow-up.Conclusions s ST2 and inflammatory factors have good prognostic value in patients with acute HFr EF.After hemodynamic stabilization in hospitalized patients with acute HFr EF,early application of Sacubitril/valsartan can reduce serum concentrations of s ST2 and pro-inflammatory factors,increase serum concentrations of anti-inflammatory factors,and improve left ventricular remodeling.In addition,the earlier the patients were increased to the target dose,the more significant the decrease of s ST2 and serum concentration of proinflammatory factors,the increase of serum concentration of anti-inflammatory factors and the improvement of left ventricular remodeling were.In addition,early administration of Sacubitril/valsartan can reduce hospital readmission and death due to heart failure in acute HFr EF,and is safe and well tolerated. |
PDF Full Text Request