ABSTRACT
Objective:
To investigate the
serum levels of soluble
growth stimulation expression
gene 2
protein (sST2) and inflammatory factors in
patients with acute left
ventricular ejection fraction reduction
heart failure (HFrEF) treated with sacubitril/
valsartan.
Methods:
Ninety six
patients with acute HFrEF admitted in The Affiliated
Hospital of Qingdao
University from March 2020 to March 2021 were enrolled. The
patients were treated with sacubitril/
valsartan,the
dose was gradually increased from 50 mg b.i.d to the target
dose of 200 mg b.i.d according to
hemodynamics. After 12 weeks, the target
dose was achieved in 72 cases (
compliance group), and did not achieved in 24 cases (non-
compliance group). The
serum levels of sST2,
IL-1β,
IL-6, TNF-αand
IL-10 were measured and compared between the two groups. The changes in left atrial anteroposterial diameter (LA), left ventricular end-diastolic diameter (LVDd) and left
ventricular ejection fraction (LVEF) values were assessed with
echocardiography. The adverse reactions, readmission rate and all-cause
death within 3 months after discharge were compared between the two groups.
Results:
A total of 96
patients with acute HFrEF completed the follow-up, including 72
patients (75.0%) in the
compliance group and 24 (25.0%) in the non-
compliance group;
aged 50-75 (66.1±6.7) years old, and 68 (70.8%)
males.
After treatment, the
serum levels of sST2,
IL-1β,
IL-6 and TNF-α were decreased, and the
IL-10 level was increased in both groups ( P<0.05); while the improvement of
serum indicators in the
compliance group was more marked ( P<0.05).
Echocardiography showed that the LA, LVDd, and LVEF were significantly increased
after treatment ( P<0.05) in
compliance group, while there was no significant changes before and
after treatment in the non-
compliance group. 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. No deterioration of renal function and
angioedema were observed in both groups, and there was no significant difference in
hyperkalemia (two in
compliance group and one in non-
compliance group), symptom
hypotension (each in two groups) between the two groups (χ 2=0.12, 0.68; P>0.05). In the non-
compliance group, 10
patients (41.7%) were readmitted due to
heart failure, and 6
patients (25.0%) died; while there were no readmitted cases or fatal cases in
compliance group (χ 2=33.49, 19.20; P<0.05).
Conclusion:
Early application of sacubitril and
valsartan sodium in
patients with acute HFrEF after
hemodynamic stabilization can significantly improve
left ventricular remodeling, for those with earlier escalation to the target
dose, it is more beneficial. The changes of
serum sST2 and inflammatory factor level
after treatment may predict the
efficacy of sacubitril/
valsartan therapy.