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Heart failure is a severe cardiovascular condition when the heart fails to adequately pump blood or oxygen to support the body’s organs. Sacubitril/valsartan, an emerging angiotensin receptor-neprilysin inhibitor (ARNI) known for its superior efficacy to conventional treatments, has revolutionized the management of heart failure. The United States Food and Drug Administration has approved the drug’s use in treating patients with chronic heart failure with reduced ejection fraction (HFrEF). Clinical trials have demonstrated its effectiveness in reducing hospitalizations and mortality rates associated with heart failure across various patient populations, including those with low ejection fraction. Numerous significant clinical trials have investigated the drug’s safety and efficacy in treating individuals with heart failure and a failing systemic right ventricle. This review delves into the current landscape of cardiovascular medicine, the role of pharmacology, and the safety profile of this medication.
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Resumen Introducción: La adherencia al tratamiento de la falla cardiaca en la vida real es subóptima. Se desconoce la adherencia a las recomendaciones del uso de sacubitril/valsartán en Colombia. Objetivo: Evaluar la frecuencia de uso, la distribución geográfica y las características demográficas de los pacientes a quienes se les formuló sacubitril/valsartán en 2019-2020, utilizando los datos del Sistema Integrado de Información de Protección Social (SISPRO). Materiales y método: Estudio descriptivo de corte transversal, en el que se extrajo la información relativa a la distribución de la prescripción del medicamento por departamento, género, quinquenio de edad y los códigos CIE-10 con los cuales se indicó. Resultados: Entre los años 2019 y 2020, se prescribieron 23.026 pacientes con sacubitril/valsartán en Colombia, de los cuales el 63.86% fueron hombres. El 92% de las prescripciones se hicieron a pacientes mayores de 50 años. Las regiones del país con mayor frecuencia de prescripción fueron Bogotá, Sucre y Santander. Conclusiones: Con base en la prevalencia estimada de falla cardiaca (2 a 3%), la frecuencia de formulación de sacubitril/valsartán en Colombia es menor a la esperada. Las regiones rurales del país son las que presentan el menor uso, lo que sugiere barreras de acceso que deben ser exploradas.
Abstract Introduction: Real-life adherence to the management of heart failure is suboptimal. Adherence to the recommendations for the use of sacubitril/valsartan in Colombia is unknown. Objective: To assess the frequency of use, geographic distribution, and demographic characteristics of patients who were prescribed sacubitril/valsartan in 2019-2020, using data from the "Sistema Integrado de Información de Protección Social" (SISPRO). Materials and method: This is a descriptive cross-sectional study. Information was extracted on the prescription distribution by department, gender, five-year age groups and the ICD-10 codes with which the medication was prescribed. Results: Between 2019 and 2020, 23,026 patients in Colombia were prescribed sacubitril/valsartan; 63.86% of the patients were men. Ninety-two percent of the prescriptions were for patients over the age of 50. The regions of the country with the highest prescription frequency were Bogotá, Sucre and Santander. Conclusions: Taking into account the estimated prevalence of heart failure (2-3%), the frequency with which sacubitril/valsartan is prescribed in Colombia is lower than expected. The rural regions of the country have the lowest use, which suggests access barriers that should be explored.
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Objective The aim of this study was to evaluate the efficacy and side effects of sacubitril/valsartan in the treatment of patients with chronic kidney disease(CKD)at stage 5 with resistant hypertension,and to explore the cardiovascular benefits and security of medical in the patients.Methods Patients with CKD5 resistant hypertension diagnosed and treated in the First Affiliated Hospital of Guangxi Medical University from September 2020 to March 2022 were selected and divided into the observation group(treated with routine treatment of kidney disease at end-stage and sacubitril/valsartan)and control group(include droutine treatment of renal disease at end-stage and ACEI or ARB drugs)according to treatment strategy.The patients in both two groups were treated with adequate dialysis treatment and conventional drug treatment of renal disease at end-stage.The patients were followed up for at least 3 months,the clinical efficacy of three months after treated with sacubitril/valsartan was observed,and the efficacy indicators and security indicators and adverse cardiovascular events were observed,the occurrence of adverse effects during the period of drug use were compared with the control group.Results A total of 110 patients were included in this study and there were 55 cases in each group.There were no significant differences in gender,age,age of dialysis,etiology,dialysis mode and blood pressure between the two groups(P>0.05).The Systolic blood pressure(SBP),diastolic blood pressure(DBP),b-type urinary natriuretic peptide precursor(Pro-BNP)and cardiac function grade in the observation group after treatment was significantly decreased compared with before treatment.The left ventricular ejection fraction(LVEF)and the ratio of LVEF<50%in the observation group was significantly reduced after treatment(P<0.05).SBP,DBP and Pro-BNP decreased 3 months after treatment compared with the baseline before treatment,and improved significantly in the first month after treatment(P<0.05).The decrease of DBP and BNP before and after treatment was significantly different between the two groups,and the decrease of DBP and BNP was more significant in the observation group(P<0.05).The difference of LVEF and left ventricular end diastolic diameter(LVEDD)between the two groups before and after treatment was statistically significant,and the improvement was more obvious in the observation group(P<0.05).There were no significant differences in the safety indicators of serum potassium,estimated glomerular filtration rate(eGFR)and liver function between two groups before and after treatment(P>0.05).In terms of adverse reactions,only 1 case in the control group developed hyperkalemia within 3 months of follow-up,and no hypotension or other adverse reactions occurred in the two groups.Conclusions The treatment of patients with CKD stage 5 hypertension with sacubitril/valsartan has obvious cardiovascular benefits.Sacubitril/Valsartan has efficacy in lowering blood pressure,improving cardiac function and reducing volume load,with less adverse events and higher safety than control group.
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Objective To investigate the efficacy and safety of sacubitril valsartan in the treatment of heart failure(HF)of midrange ejection fraction(HFmrEF)in patients after acute myocardial infarction(AMI).Methods A total of 102 patients with HFmrEF after AMI were divided into the control group and the experimental group,with 51 cases in each group.The control group was given conventional treatment for AMI and anti-HF treatment,and the angiotensin-converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB)was used without contraindications.The experimental group was replaced by ACEI/ARB with sacubitril valsartan on the basis of the control group.After 6 months of treatment,the total effective rates of the two groups after treatment were analyzed,and the cardiac function,N-terminal pro-brain natriuretic peptide(NT-proBNP)and serum inflammatory factor C-reactive protein(CRP)were compared before and after treatment.The occurrence of adverse reactions after treatment was recorded.Kaplan-Meier method was used to analyze the cumulative cardiovascular mortality,HF rehospitalization rate and end-event-free survival after 6 months of treatment in two groups.Results After treatment,there was no significant difference in the occurrence of adverse reactions between the two groups(P>0.05).The total effective rate was higher in the experimental group than that of the control group(P<0.05).Compared with before treatment,left ventricular ejection fraction(LVEF),stroke volume(SV),mitral diastolic blood flow velocity E peak and A peak ratio(E/A)and 6 min walking distance(6MWD)were increased in the two groups,and left ventricular end-diastolic diameter(LVEDD)and left atrial diameter(LAD)were decreased in the two groups after treatment(all P<0.05).After treatment,LVEF,SV,E/A and 6MWD were higher in the experimental group than those in the control group(P<0.05).LVEDD and LAD were lower than those in the control group(all P<0.05).Compared with results before treatment,NT-proBNP and CRP were decreased after treatment in the experiment group than those in the control group(P<0.05).There was no significant difference in the cumulative cardiovascular mortality between the experiment group and the control group(3.9％vs.5.9％,P=0.524).The cumulative HF rehospitalization rate was lower in the experimental group than that of the control group(9.8％vs.23.5％,P=0.042).The cumulative end-point-free survival rate was higher in the experiment group than that of the control group(86.3％vs.70.6％,P=0.037).Conclusion Sacubitril valsartan is safer and more effective than ACEI/ARB in the treatment of AMI patients with HFmrEF,and it is worthy of clinical promotion.
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Objective:To explore therapeutic effect of sacubitril valsartan sodium combined with Wenxin granule in the treatment of hypertension complicated with paroxysmal atrial fibrillation(AF)and its effect on cardiac electro-physiological structure.Methods:A total of 116 patients with hypertension and paroxysmal atrial fibrillation treated in our hospital from Oct 2021 to Nov 2022 were consecutively selected.According to random number table,they were divided into Wenxin granule group(received Wenxin granule treatment based on routine antihypertensive ther-apy)and combined treatment group(received sacubitril valsartan sodium combined Wenxin granule therapy based on routine antihypertensive therapy)with 58 cases in each group,and both groups were consecutively treated for six months.Clinical symptom score,AF burden,P wave duration,P wave dispersion,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)were compared between two groups before and after treatment.Results:After treatment,compared with Wenxin granule group,there were significant reductions in clinical symptom score[(1.66±0.69)scores vs.(1.40±0.53)scores],AF burden[4.43(1.65)％vs.1.62(3.50)％],P wave duration[(112.17±6.46)ms vs.(109.29±8.59)ms],P wave dispersion[(32.47±8.11)ms vs.(29.02±7.49)ms]and LAD[(34.83±3.41)mm vs.(33.40±3.74)mm]in combined treatment group(P＜0.05 or＜0.01).There were no significant difference in LVEDd and LVEF between two groups,P＞0.05 both.Conclusion:Sacubitril valsartan sodium combined with Wenxin granule can significantly im-prove clinical symptoms and atrial fibrillation burden,reduce the susceptibility to atrial fibrillation,and inhibit atrial electrical remodeling and structural remodeling in patients with hypertension complicated with paroxysmal atrial fi-brillation.
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Objective To retrospective analyze the use of inpatients taking sacubitril/valsartan in Nanjing Drum Tower Hospital,and to provide references for rational clinical application.Methods The relevant data of inpatients taking sacubitril/valsartan in our hospital were systematically collected from July 2019 to September 2021,and the rationality of drug use was eval-uated.Results A total of 2 682 cases were collected,and 868 cases(32.36%)of them involved 918 times of irrational drug use.The specific situations of irrational drug use included off-label use(182 times),irrational usage and dosage(389 times),irrational conversation of drugs(251 times),and irrational drug use for special populations(96 times).Conclusion The use of sacubitril/valsartan exists in unreasonable situations in our hospital.Clinical pharmacists should participate in medication man-agement to a certain extent,strengthen the pharmaceutical care of patients,and improve the rational rate of drug use.
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Objective To investigate the efficacy of sakubatril valsartan combined with tolvaptan in the treatment of heart failure patients with reduced ejection fraction(HFrEF)and the effects on echocardiography and cardiovascular events.Methods According to the random number table method,400 patients with HFrEF admitted to the First People's Hospital from September 2017 to January 2022 were divided into the control group and the combination group with 200 cases each.Both groups were given conventional treatment,based on which the control group was given sacubitril valsartan and the combination group was given sacubitril valsartan combined with tolvaptan.The efficacy,echocardiographic indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),left ventricular end-systolic internal diameter(LVESD)],myocardial injury indexes[serum brain natriuretic peptide(BNP),high-sensitivity troponin T(hs-CTnT),growth transforming factor-15(GDF-15)],urine output,neuroendocrine factors[antidiuretic hormone(ADH),angiotensin(PRA),angiotensin Ⅱ(Ang Ⅱ)],cardiovascular events and adverse effects were compared between the two groups.Results The total effective rate was 94.50%(189/200)higher in the combined group than 86.00%(172/200)in the control group(P＜0.05);LVEF was high-er in the combined group than in the control group after treatment,and LVEDD and LVESD were lower than in the control group(P＜0.05);BNP,hs-CTnT,GDF-15,ADH PRA,and Ang II were lower in the combined group than in the control group,and urine volume was higher than in the control group(P＜0.05);at 6-month follow-up after treatment,there were no statistically significant differences in the rehospitalization rate of heart failure,the incidence of non-fatal infarction,post-discharge cardiovascular mortali-ty and all-cause mortality in the combined group compared with those of the control group(P＞0.05);there were no statistically significant differences in the incidence of adverse events in the combined group compared with that of the control group(P＞0.05).Conclusion Sacubitril valsartan combined with tolvaptan is effective in treating HFrEF,by reducing myocardial inju-ry,promoting urination,and improving patients'cardiac function without increasing the risk of cardiovascular events and adverse reactions.
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As a new strategy for the application of sacubitril/valsartan (LCZ696) in patients with CKD, much evidence showed that it improved the prognosis of patients with CKD. This review summarizes the efficacy and safety of sacubitril/valsartan in physiology, pathology, pharmacology and clinical application by searching Wanfang, CNKI, PubMed and other databases for related articles on the application of sacubitril/valsartan in CKD patients. Although LBQ657, the active product of sacubitril, has a high drug accumulation in patients with moderate, severe renal injury, and ESRD, it is not cleared in hemodialysis, and has very little eliminated in peritoneal dialysis, which does not affect its safety. Compared with angiotensin converting enzyme inhibitor and angiotensin receptor blocker drugs, LCZ696 could increase the blood pressure control rate, improve cardiac function, slow down the decline of glomerular filtration rate, and significantly improve cardiovascular outcomes without more adverse events. Sacubitril/valsartan can be used in all levels of CKD patients complicated with hypertension and/or heart failure, with reliable safety and tolerance.
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Objective To explore the application effect of sacubitril valsartan in patients with chronic heart failure(CHF).Methods A total of 66 CHF patients admitted to Xinyu Yuanhe Hospital from September 2021 to September 2022 were selected and divided into control group and study group according to random number table method,with 33 cases in each group.The control group was treated with benazepril + spironolactone + metoprolol,and the study group was treated with sacubitril valsartan + spironolactone + metoprolol.The clinical efficacy,ventricular remodeling,cardiac function,serum factor levels and adverse reactions were compared between two groups.Results The total effective rate in study group was significantly higher than that in control group(χ2=5.974,P=0.015).After treatment,left ventricular mass index,myocardial wall stress,left ventricular posterior wall thickness,left ventricular ejection fraction,N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensin Ⅱ and aldosterone in study group were significantly lower than those in control group,and left ventricular remodelling index,stroke volume and left ventricular end-diastolic volume were significantly higher than those in control group(P<0.05).There was no significant difference in adverse reactions between two groups(P>0.05).Conclusion The treatment effect of sacubitril valsartan in CHF patients is significant,which can effectively improve cardiac function indicators,reverse ventricular remodeling,reduce serum NT-proBNP level,and have fewer adverse reactions.
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OBJECTIVE To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension. METHODS A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment. RESULTS After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （P＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （P＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication. CONCLUSIONS Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia.
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Objective To study the therapeutic effect of Xuefu Zhuyu Capsule combined with sacubitril valsartan on dilated cardiomyopathy.Methods A total of 70 patients with dilated cardiomyopathy who were hospitalized in the Hospital from January to December 2020 were selected as the research objects and random-ly divided into control group and experimental group,with 35 cases in each group.The control group was only treated with sacubitril valsartan,and the experimental group was treated with Xuefu Zhuyu Capsule combined with sacubitril valsartan.According to the patient's blood pressure and renal function,sacubitril valsartan was titrated from a small dose to the maximum dose.Xuefu Zhuyu Capsule was uesd 2.4 g each time,twice a day,and the treatment time was three months.The symptoms of heart failure,glycosylated hemoglobin(HbA1c),low density lipoprotein(LDL),total cholesterol(TC),triglyceride(TG),ALT,AST,N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end-systolic diameter(LVEDd),left ventricular end-dias-tolic diameter(LVEDs),ejection fraction(EF)and the incidence of arrhythmia were observed in the two groups after treatment.Results After treatment,the level of NT-proBNP in the experimental group was sig-nificantly lower than that in the control group(P＜0.05).There was no significant difference in LDL,TC,TG,LVEDd,LVEDs and EF between the two groups(P＞0.05).The incidence of atrial tachycardia and ven-tricular premature beat in the experimental group was higher than that in the control group(P＜0.05).Con-clusion Xuefu Zhuyu Capsule combined with sacubitril valsartan can significantly improve the symptoms of patients with heart failure and reduce the level of NT-proBNP,but it may increase the proportion of patients with atrial tachycardia and ventricular premature beats.
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Background: Ramipril and sacubitril/valsartan are used in the management of ACS patients with left ventricle systolic dysfunction. The objective of the study was to compare ramipril and sacubitril/valsartan in improving LVEF in post ACS patients with LVEF <40%. Methods: A randomized, prospective, open label, comparative study was carried out in department of pharmacology and cardiology at Dr. R. P. G. M. C. Kangra at Tanda, Himachal Pradesh. The study was carried for a period of one and a half year. Out of 80 patients, 38 patients were in ramipril group and 42 were in sacubitril/valsartan group. Data was presented as mean±SD, frequency and percentage. Student’s t test and chi square test were used and p value<0.05 was considered significant. Results: In both the groups, a statistically significant improvement was observed in terms of improvement in LVEF at 6th month when compared to baseline, however, at 6th month both the groups were comparable in terms of LVEF improvement with p value of 0.275. Conclusions: The study concluded that both the drugs have same efficacy in improving LVEF in post ACS patients at 6th month.
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Esta es una revisión sobre el papel de los péptidos natriuréticos y los intentos de utilizarlos como diana terapéutica a medida que se iba comprendiendo mejor su papel en la fisiopatología de la insuficiencia cardíaca con función sistólica deprimida. Se hace un recuento de su participación en sucesivos estudios fallidos y se explican los motivos de sus fracasos, hasta lograr el éxito deseado con la combinación del sacubitrilo/valsartan, lo que produjo un cambio de paradigma en el manejo de la insuficiencia cardíaca.
This review is conducted on the role of natriuretic peptides and the attempts to use them as a treatment as their role in the pathophysiology of heart failure with depressed systolic function was better understood. A recount of their participation in successive failed studies is provided, explaining the reasons for their failures, until achieving the desired success with the combination of sacubitril/valsartan. This produced a paradigm shift in the management of heart failure.
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Objective:To study the effects of sacubitril valsartan sodium on vascular sclerosis and ventricular remodeling in patients with ischemic cardiomyopathical coronary heart disease.Methods:A prospective research method was adopted. One hundred and eighty-six patients with coronary heart disease who were treated in Hangzhou Ninth People′s Hospital from January to December 2021 were selected and divided into control group and observation group by random digits table method, with 93 cases in each group. The control group adopted routine treatment method of aspirin + metoprolol + nitroglycerin + captopril according to the guideline, while the observation group was additionally treated with sacubitril valsartan sodium on the basis of the control group. The clinical efficacy, vascular endothelial function and hardness, cardiac function, ventricular remodeling and adverse reactions were compared between the two groups.Results:The total effective rate of treatment in observation group was significantly higher than that in control group: 96.77%(90/93) vs. 87.10%(81/93), and there was statistical difference ( P<0.05). After treatment, the brachial artery flow-mediated dilation in observation group was significantly higher than that in control group: (14.46 ± 2.80)% vs. (13.09 ± 2.74)%, the level of endothelin-1 was significantly lower than that in control group: (73.32 ± 9.63) ng/L vs. (77.47 ± 10.35) ng/L, and there were statistical differences ( P<0.05). After treatment, the left ventricular ejection fraction (LVEF) in observation group was significantly higher than that in control group: (50.87 ± 3.52)% vs. (49.72 ± 3.71)%, the left ventricular end-systolic diameter, left ventricular end-diastolic diameter and ventricular remodeling indicators of interventricular septal thickness and left ventricular mass index were significantly lower than those in control group: (38.26 ± 5.18) mm vs. (40.05 ± 5.20) mm, (50.49 ± 4.33) mm vs. (52.08 ± 4.25) mm, (8.95 ± 0.39) mm vs. (9.08 ± 0.41) mm, (118.49 ± 9.58) g/m 2 vs. (121.58 ± 9.62) g/m 2, and there were statistical differences ( P<0.05). There were no statistical differences in the levels of total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol after treatment between the two groups ( P>0.05). There were no statistical differences in the incidences of adverse reactions between the two groups ( P>0.05). Conclusions:Sacubitril valsartan sodium has a good clinical efficacy in the treatment of coronary heart disease, and it can improve cardiac function and vascular sclerosis and reverse ventricular remodeling. In addition, it has no significant adverse reactions and is conducive to disease recovery.
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OBJECTIVE To analyze the research status and development trends of the use of sacubitril/valsartan. METHODS Related literature about the use of sacubitril/valsartan were retrieved from CNKI and the core database of Web of Science. CiteSpace 5.8.R3 software was used to analyze authors， countries/areas， institutions and keywords. RESULTS & CONCLUSIONS Totally 1 193 Chinese literature and 1 060 English literature were included. The number of literature increased， with numerous literature covering the United States （429）， the United Kingdom （185） and China （184）. ZHANG Jing （5） and Solomon S D （118） published the highest number of Chinese and English articles. The authors of Chinese literature had less cooperation while the authors of English literature were in close contact. Dept. of Cardiology in the First Affiliated Hospital of Zhengzhou University （9）， Dept. of Cardiology in the Affiliated Hospital of Xuzhou Medical University （9） and Novartis AG （134） had the highest quantity of publications of Chinese and English literature. The institutions of Chinese literature had a small number of overall publications and less cooperation while the institutions of English literature were closely connected. The clinical efficacy of sacubitril/valsartan for heart failure， hypertension and their complications were research hotspots in Chinese and English literature. Chinese scholars and research teams need to strengthen cooperation and communication in the future， as well as conduct research from the perspectives of sacubitril/valsartan in the treatment of heart failure， hypertension and related complication， the improvement of oxidative stress， and the evaluation of the efficacy of combination therapy with dapagliflozin.
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Objective:To observe the effects of sacubitril/valsartan (LCZ696) on viral replication and cardiomyocyte apoptosis in mice with coxsackievirus B3 (CVB3)-induced viral myocarditis (VMC) and to analyze the underlying mechanisms.Methods:Forty BALB/c mice were randomly divided into four groups with 10 in each group: Sham, Sham+ LCZ696, VMC, and VMC+ LCZ696 groups. VMC model was established by intraperitoneal injection of 0.1 ml of CVB3 with a concentration of 10 6 TCID 50/ml into BALB/c mice, while the sham intervention was an equal volume of saline. The day of virus injection was defined as day 0. LCZ696 was administered by gavage at a dose of 60 mg/kg every day for seven consecutive days starting from day 1. Mouse survival rates were calculated. Echocardiography was used to evaluate the cardiac function of mice. The level of creatine kinase-MB (CK-MB) was detected by ELISA. Western blot was used to detect the levels of inflammatory cytokines (IL-6, TNF-α), apoptosis-related proteins (caspase-3, cleaved-caspase-3, Bax, Bcl-2), CVB3 surface protein (VP-1) and p-AKT/AKT in the hearts of mice. CVB3 mRNA in mouse hearts was measured by PCR. Inflammatory cell infiltration and cell apoptosis in mouse hearts were observed by HE staining and TUNEL staining, respectively. Results:Compared with the Sham group, the mice in the VMC group had a decreased survival rate and impaired cardiac function ( P<0.05). The levels of CK-MB, IL-6, TNF-α, cleaved-caspase-3/caspase-3, Bax/Bcl-2, VP-1, and CVB3 mRNA in the hearts of VMC mice increased significantly ( P<0.05), accompanied by increased expression of AKT, decreased phosphorylation of AKT ( P<0.05) and increased cell apoptosis. LCZ696 reversed the above changes. It could increase the survival rate, improve the cardiac function ( P<0.05), decrease cardiac inflammation, cell apoptosis and viral replication ( P<0.05), and increase the phosphorylation of AKT ( P<0.05). LCZ696 had no significant effects on the survival rate, cardiac function, myocardial injury, cardiac inflammation, cell apoptosis, viral replication or the expression of PI3K/AKT signaling pathway-related proteins in normal mice. Conclusions:LCZ696 could significantly inhibit cardiomyocyte apoptosis and reduce CVB3 replication in the hearts of VMC mice by regulating the PI3K/AKT pathway, thereby improving mouse cardiac function and survival rate.
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【Objective】 To observe the clinical effect of combination therapy of sacubitril valsartan and dapagliflozin in heart failure with reduced ejection fraction (HFrEF) and non-diabetes patients. 【Methods】 This study involved 96 patients with HFrEF and non-diabetes. The patients were randomly divided into control group (50 cases) and observation group (46 cases). On the basis of routine treatment, the control group was treated with sacubitril valsartan, while the observation group was treated with sacubitril valsartan and dapagliflozin. After 1-month and 6-month treatment, we monitored blood pressure, N-terminal pro brain natriuretic peptide (NT-proBNP), high sensitivity troponin T (cTnT), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left atrial diameter (LAD), left ventricular posterior wall thickness (LVPW), Minnesota soda heart failure life quality score (MLHFQ), the incidence of rehospitalization and death, and major adverse cardiovascular events (MACE) in the two groups. 【Results】 After 6 months, systolic blood pressure, cTnT, NT-proBNP, LVEDd, LVPW, and LAD of the observation group were significantly decreased compared with the control group (P0.05). 【Conclusion】 The combination treatment of sacubitril valsartan and dapagliflozin on HFrEF and non-diabetes patients can significantly improve cardiac function, inhibit myocardial remodeling, reduce the incidence of MACE, and improve the prognosis.
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Objective To observe the effects of sacubitril-valsartan tablets on the expressions of N terminal pro B type natriuretic peptide(NT-proBNP),troponin Ⅰ(cTnⅠ)and cardiac function in patients with chronic cardiac insufficiency.Methods Patients with chronic cardiac insufficiency who were diagnosed and treated in Beijing Friendship Hospital of Capital Medical University from November 2021 to December 2022 were selected as the study subjects,and were divided into the study group(sacubitril-valsartan tablets)and the control group(valsartan capsules)according to the random number table method.The total effective rate,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end-diastolic diameter(LEVDD)],plasma NT-proBNP,cTnⅠ,soluble growth stimulation expression gene 2 protein(sST2),angiotensin(AngⅡ)and the incidence of adverse reactions were observed in the two groups.Results A total of 100 patients with cardiac insufficiency were included in the study,with 50 in the study group and 50 in the control group.After treatment,the total effective rate of the study group was higher than that of the control group(P＜0.05).The LVEF in the study group was significantly higher than that in the control group,while the LVESD,LEVDD were significantly lower than those in the control group(P＜0.05).After treatment,the plasma of NT-proBNP,cTnⅠ,AngⅡ,and sST2 in two groups had statistical difference(P＜0.05)and the difference in the above indicators before and after treatment in two groups were statistically siginficant(P＜0.05).The differences in adverse reactions between two groups were not statistically significant(P＞0.05).Conclusion The treatment of chronic heart failure patients with sacubitril-valsartan tablets can improve heart function,prognosis,and safety.
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Objective To investigate the efficacy of sacubitril/valsartan combined with sodium ni-troprusside in treatment of acute heart failure(AHF)in elderly patients.Methods A total of 280 elderly AHF patients admitted in our hospital from June 2020 to June 2021 were enrolled and ran-domly divided into control group(143 cases,sodium nitroprusside treatment)and observation group(137 cases,sodium nitroprusside+sacubitril/valsartan).Their indicators in hemodynamics,cardiac function and vascular endothelial function,neurohormone factors and clinical total effec-tive rate were compared between 2 groups.Results After treatment,the observation group ob-tained significantly lower central venous pressure,mean arterial pressure,pulmonary vascular re-sistance,peripheral vascular resistance,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular end systolic volume,and levels of endothelin 1,N-terminal-type B natriuretic peptide precursor and noradrenaline,but higher LVEF and NO levels than the con-trol group(P＜0.01).The total effective rate was statistically higher(97.08％vs 86.71％,P=0.002),but the incidence of adverse reactions was notably lower(11.68％vs 20.98％,P=0.036)in the observation group than the control group.Conclusion The combined treatment reduces he-modynamic indicators and neurohormone factors,and regulates the cardiac function and vascular endothelial function in elderly AHF patients.It is superior to sodium nitroprusside monotherapy with better total effectiveness but lower incidence of adverse reactions.