| Objective:This study aims to explore the effects of Dapagliflozin combined with Entresto on systolic function,diastolic function,myocardial remodeling and safety in patients with chronic heart failure complicated with diabetes mellitus(DM),as well as the effects of treatment regimen of Dapagliflozin combined with Entresto on blood pressure in patients with different levels of cardiac function.It provides a reference for the treatment and prognosis evaluation of patients with chronic heart failure complicated with diabetes.Methods:Patients with chronic heart failure complicated with diabetes who were hospitalized in the department of cardiovascular Medicine of our hospital from August 2020 to August 2021 were selected,according to different treatment regiments,they were divided into group A(conventional treatment combined with Dapagliflozin and Entresto,referred to as Dapagliflozin and Entresto group)and Group B(conventional treatment combined with Entresto,referred to as Entresto group).Patients were followed up for 6 months,and the data of patients before and after treatment were collected for statistical analysis.Routine treatment includes routine hypoglycemic and anti-heart failure therapy.At the same time,patients in group A were regrouped according to their cardiac function grades before treatment to explore the effects of Dapagliflozin combined with Entresto on blood pressure.SPSS26.0 was used to count and analyze related indicators,P<0.05 was considered statistically significant;The therapeutic effect was observed and the clinical difference was evaluated.Results:Comparison of Dapagliflozin combined with Entresto group and Entresto group:1.Before treatment,there was no statistical difference in cardiac output(CO),left ventricular ejection fraction(LVEF)level,left atrial diameter,left ventricular end-diastolic diameter,interventricular septum thickness and posterior wall thickness,filling peak of early diastolic rapid filling/filling peak of late diastolic rapid filling(E/A),6 minutes walk test levels,N terminal b-type natriuretic peptide precursor(NT-pro BNP),creatinine,and urine specific gravity,24 hours urinary protein and glycated hemoglobin level between the two groups.After treatment,compared with the Entresto group,the left atrial inner diameter,left ventricular end diastolic inner diameter,NT-prob NP and 24-hour urinary protein levels were lower in the Dapagliflozin combined with Entresto group,and the CO,LVEF,E/A and urine specific gravity levels were higher,the distance of 6-minute walking test was longer,with statistically significant differences.After treatment,there was no significant difference in glycated hemoglobin level between the two groups,but the glycated hemoglobin level was decreased in both groups,with statistically significant differences.After treatment,creatinine,thickness of interventricular septum and thickness of posterior wall in 2 groups were not significantly changed compared with before,and urine specific gravity in Entresto group was not significantly changed compared with before,the difference was not statistically significant.2.Before treatment,there was no statistical difference in renin,angiotensin II and aldosterone levels between the two groups.After treatment,the levels of renin,angiotensin II and aldosterone were lower in the Dapagliflozin combined with Entresto group compared with the Entresto group,and the differences were statistically significant.3.Dapagliflozin combined with Entresto can better improve patients’ NYHA cardiac function grade and ventricular diastolic function,and effectively reduce the incidence of atrial fibrillation,with statistically significant difference.4.There was no significant difference in the occurrence of acute heart failure,acute myocardial infarction,ischemic stroke,severe hypotension,severe renal insufficiency,severe liver insufficiency,diabetic ketoacidosis,diabetic hyperosmolar coma and death between the two treatment regiments.Effects of Dapagliflozin combined with Entresto on blood pressure levels of patients with different NYHA cardiac function grades in Group A:1.Before treatment,systolic blood pressure and pulse pressure levels of patients with grade II and III cardiac function were higher than those of patients with grade IV cardiac function,and the differences were statistically significant,while there was no statistical difference in diastolic blood pressure levels of patients with different grades of cardiac function.2.After treatment,patients with different cardiac function grades had different drops in blood pressure(systolic and diastolic blood pressure),and patients with poorer cardiac function had greater drops in blood pressure(systolic and diastolic blood pressure),with statistically significant differences.Conclusions:1.Treatment with Dapagliflozin combined with Entresto can better improve systolic function,diastolic function,myocardial remodeling,incidence of atrial fibrillation and 24-hour urinary protein levels in patients with chronic heart failure and diabetes.2.Patients with chronic heart failure combined with diabetes had worse cardiac function,lower systolic and pulse pressure levels,and worse tolerance of Dapagliflozin combined with Entresto in terms of blood pressure,with a greater drop in blood pressure.3.The treatment regimen of Dapagliflozin combined with Entresto is safe. |
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