Effects Of Sacubitril/valsartan On Cardiac Function And Ventricular Arrhythmias In Chronic Heart Failure Patients With Implanted Cardioverter Defibrillator Implantation

Objective(s):To investigate the effects of sacubitril valsartan(S/V)on cardiac function in chronic heart failure(CHF)patients with implanted cardioverter defibrillator(ICD)for primary prevention of sudden cardiac death(SCD)and the effect of S/V on ventricular arrhythmias in patients with chronic heart failure with reduced ejection fraction(HFrEF).Methods:HFrEF patients with ICD implantation for primary prevention of sudden cardiac death and received S/V treatment in the Department of Cardiovascular Medicine of the the First People’s Hospital of Yunnan Province during the period from September2017 to December 2022.(1)Statistics the dose of S/V at 12 months of follow-up,and UCG indicators at 3,6,and 12 months of treatment(LVEF、LVEDD、LAD);(2)Ventricular arrhythmia events and therapy recorded by ICD,Holter parameters:Average number of ventricular premature beats per hour、corrected mean QT interval(QTc)and Standard deviation of normal cardiac cycles(SDNN).(3)Whether there are adverse reactions and readmission rate.Statistical analysis with SPSS 23.0,and P<0.05 was statistically significant.Results:A total of 56 HFrEF patients who received S/V treatment and with ICD implantation for primary prevention of sudden cardiac death were included,including19(33.93%)patients with ischemic cardiomyopathy,37(66.07%)patients with dilated cardiomyopathy;In this study,10 patients reached the maximum standard dose of S/V,and the average dose of 94.6 mg bid for all patients at one year follow-up.Following up for 3 months,LVEF,LVEDD,and LAD in patients with ischemic cardiomyopathy and patients with dilated cardiomyopathy improved compared to before treatment;Following up for 6 months,LVEF,LVEDD,and LAD in patients with ischemic cardiomyopathy and patients with dilated cardiomyopathy improved compared to 3 months of treatment;LVEF,LVEDD,and LAD in patients with ischemic cardiomyopathy and patients with dilated cardiomyopathy improved after 12 months of follow-up compared to 6 months of treatment,the differences was statistically significant.The echocardiography features included LVEF,LVEDD and LAD had no statistically significant difference between patients with ischemic cardiomyopathy and patients with dilated cardiomyopathy at followed-up 3 months,6months,and 12 months.Of all patients followed up,compared with the follow-up period of 1-6 months,there was a decrease in the number of VT/VF、Mon-VT、nonsustained VT(VT-NS)recorded by ICD during the follow-up period of 7-12 months.The differences in the number of premature ventricular contraction per hour were not statistically significant.Of all patients followed up,from January to June,9 patients experienced VT/VF,including VF 6 times,ATP therapy for 6 times,and 35 J electronic shock treatments 9times;VT 16 times,ATP therapy 22 times,and 35 J electronic shock treatments 2times.From July to December,6 patients experienced VT/VF,including VF twice,ATP therapy twice,and 35 J electronic shock treatments three times;VT 6 times,ATP therapy for 9 times,35 J electronic shock treatments 4 times.Of all patients followed up,compared with before treatment,the SDNN of patients increased from 94.38±26.42 ms to 102.23±20.36 ms after 1 year of follow-up,with a statistically significant difference(P<0.05);The QTc was shortened from441.92 ± 10.64 ms to 411.46 ± 6.00 ms,with a statistically significant difference(P<0.05).Of all patients did not experienced dry cough,angioedema,or hypersensitivity.One patient with ICM experienced hypotension,while two patients with DCM experienced hypotension.All patients had no renal function damage or electrolyte disorders in 1 year.Two patients with ICM were readmitted two times due to worsening heart failure within one year,with a readmission rate of 10.53%;Two patients with DCM were readmitted three times due to worsening heart failure,with a readmission rate of5.40%.Conclusion(s):1、Patients with CHF implanted with ICD for primary prevention of SCD had sustained improvements in cardiac structure and function within 1 year of treatment with S/V,and there was no difference in the degree of improvement between patients with ischaemic cardiomyopathy and patients with dilated cardiomyopathy.2、S/V reduced the incidence of ventricular arrhythmias during the follow-up period of this study.