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OBJECTIVE：To investigate the effec ts of angiotensin receptor neprilysin inhibitor （ARNI）sacubitril valsartan sodium（SVS）on the short-term prognosis of patients with acute anterior myocardial infarction （AAMI）complicated with acute cardiac insufficiency. METHODS ：A total of 80 patients with AAMI and Killip grade Ⅱ-Ⅳ of cardiac function ，who met the inclusion criteria ，were randomly divided into ARNI group and control group ，with 40 patients in each group. Both groups were given the same basic standardized drug treatment ，vital signs support treatment and percutaneous coronary intervention treatment at the same time. On this basis ，ARNI group was given SVS tablet orally ，with initial dose of 25 mg each time ，twice a day ； thereafter，gradually adjust the dose to 200 mg each time ，twice a day. Control group was given Enalapril maleate tablets orally ， with an initial dose of 5 mg each time ，twice a day ；thereafter，gradually adjust the dose to 10 mg each time ，twice a day. Both groups took medicine for a long time ，and were followed up after 1，3 and 6 months of medication to the clinic. The levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）， soluble growth stimulation expressed gene 2 protein （sST2） and echocardiography indexes were compared between 2 groups before and after medication. The 6-minute walking test （6MWT）and the incidence of cardiogenic readmission events were recorded in 2 groups after medication. RESULTS ：Compared with before treatment，the indexes of the two groups were significantly improved at 1，3 and 6 months after treatment （P＜0.05）. Compared with control group ，the levels of NT-proBNP and sST 2 in ARNI group decreased significantly （P＜0.05），the levels of left ventricular ejection fraction and 6MWT increased significantly（P＜0.05），and the left ventricular end systolic diameter and left ventricular end diastolic diameter decreased significantly，after 3 and 6 months of treatm ent（P＜0.05）. However ，there was no significant difference in the velocity ratio of peak E to peak A ，pulmonary artery pressure ，right ventricular end diastolic diameter and the incidence of cardiogenic readmission events between 2 groups（P＞0.05）. CONCLUSIONS ：For patients with AAMI complicated with acute cardiac insufficiency ， compared with enalapril ，SVS can significantly improve the cardiac function （especially the left ventricular systolic function ）， reduce the inflammatory reaction of cardiomyocytes ，protect cardiomyocytes ，so as to improve the short-term prognosis of patients.
ABSTRACT
Objective@#To investigate the influence of angiotensinreceptor neprilysin inhibitor(ARNI) and angiotensin converting enzyme inhibitor (ACEI) on clinical efficacy and safety of elderly patients with ischemic cardiomyopathy.@*Methods@#From January 2017 to December 2018, 120 elderly patients with ischemic cardiomyopathy in the Third People′s Hospital of Cixi were divided into 2 groups according to treatment methods, 59 patients treated with ACEI (control group) and 61 patients treated with ARNI (observation group) on the basis of conventional intervention. The levels of blood lipid index, blood pressure index, B-type brain natriuretic peptide (BNP), 6- minute walking test (6MWT) and echocardiographic index, endothelium-dependent diastolic function of brachial artery (FMD) and carotid intima-media thickness (CIMT) before and after treatment were compared. The adverse reactions incidence of 2 groups were compared.@*Results@#The levels of blood lipid index and blood pressure index after treatment of 2 groups were significantly lower than those before treatment, and the differences had statistical significant (P<0.05). There were no significant differences in the levels of blood lipid index and blood pressure index after treatment between 2 groups (P>0.05). After treatment of 12 weeks, the levels of BNP, 6MWT, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension(LVEDD) of observation group were significantly better than those of control group [(103.50 ± 23.95) ng/L vs. (175.20 ± 37.24) ng/L, (493.47 ± 92.54) m vs. (411.42 ± 61.09) m, (44.95 ± 5.89)% vs. (41.54 ± 4.21)%, (149.59 ± 33.26) mm vs. (143.24 ± 34.25) mm](P<0.05). The level of brachial artery FMD after treatment of observation group was significantly higher than that of control group [(15.14 ± 2.52)% vs. (9.25 ± 1.12)%](P<0.05). The level of CIMT after treatment of observation group was significantly lower than that of control group [(1.01 ± 0.28) mm vs. (1.32 ± 0.25) mm](P<0.05). There was no significant difference in the adverse reactions incidence between 2 groups (P>0.05).@*Conclusions@#ARNI in assisted treatment of elderly patients with ischemic cardiomyopathy can efficiently improve cardiac function, increase exercise endurance, enhance vasodilation function and dose not aggravate adverse drug reactions.
ABSTRACT
Objective To investigate the influence of angiotensinreceptor neprilysin inhibitor (ARNI) and angiotensin converting enzyme inhibitor (ACEI) on clinical efficacy and safety of elderly patients with ischemic cardiomyopathy.Methods From January 2017 to December 2018,120 elderly patients with ischemic cardiomyopathy in the Third People's Hospital of Cixi were divided into 2 groups according to treatment methods,59 patients treated with ACEI (control group) and 61 patients treated with ARNI (observation group) on the basis of conventional intervention.The levels of blood lipid index,blood pressure index,B-type brain natriuretic peptide (BNP),6-minute walking test (6MWT) and echocardiographic index,endothelium-dependent diastolic function of brachial artery (FMD) and carotid intima-media thickness (CIMT) before and after treatment were compared.The adverse reactions incidence of 2 groups were compared.Results The levels of blood lipid index and blood pressure index after treatment of 2 groups were significantly lower than those before treatment,and the differences had statistical significant (P ＜ 0.05).There were no significant differences in the levels of blood lipid index and blood pressure index after treatment between 2 groups (P ＞ 0.05).After treatment of 12 weeks,the levels of BNP,6MWT,left ventricular ejection fraction (LVEF),left ventricular end-diastolic dimension (LVEDD) of observation group were significantly better than those of control group [(103.50 ± 23.95) ng/L vs.(175.20 ± 37.24) ng/L,(493.47 ± 92.54) m vs.(411.42 ± 61.09) m,(44.95 ± 5.89)％ vs.(41.54 ± 4.21)％,(149.59 ± 33.26) mm vs.(143.24 ± 34.25) mm](P ＜ 0.05).The level of brachial artery FMD after treatment of observation group was significantly higher than that of control group [(15.14 ± 2.52)％ vs.(9.25 ± 1.12)％](P ＜ 0.05).The level of CIMT after treatment of observation group was significantly lower than that of control group [(1.01 ± 0.28) mm vs.(1.32 ± 0.25) mm] (P＜ 0.05).There was no significant difference in the adverse reactions incidence between 2 groups (P＞ 0.05).Conclusions ARNI in assisted treatment of elderly patients with ischemic cardiomyopathy can efficiently improve cardiac function,increase exercise endurance,enhance vasodilation function and dose not aggravate adverse drug reactions.
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Congestive heart failure (HF) is a morbidity that is increasing worldwide due to the aging population and improvement in (acute) care for patients with cardiovascular diseases. The prognosis for patients with HF is very poor without treatment. Furthermore, (repeated) hospitalizations for cardiac decompensation cause an increasing economic burden. Modern drugs and the consequent implementation of therapeutic recommendations have substantially improved the morbidity and mortality of HF patients. This paper provides an overview of the current pharmacological management of HF patients, based on the 2016 guidelines of the European Society of Cardiology (ESC).