Abstract
Background: To compare the effect of sacubitril/valsartan with benalapril on left ventricular remodeling in patients with acute myocardial infarction. Materials and Methods: 85 patients with acute ST segment elevation myocardial infarction who were treated with PCI in the Second Affiliated Hospital of Tianjin Medical University. The patients were randomly divided into two groups: the experimental group (sacubitril/valsartan, 25-100mg/d, BID) and the control group (benalapril, 5-10mg, QD). Color Doppler echocardiography was performed after 1 month and 3 months respectively, interventricular septal thickness, septal motion amplitude, left ventricular end diastolic diameter, left ventricular end systolic diameter, posterior wall thickness, posterior wall motion amplitude, LVEF, left ventricular weight, left ventricular weight index, NT Pro-BNP, gender, height, weight, body surface area were collected. In order to evaluate the influencing factors in the process of ventricular remodeling, binary multivariate logistic regression analysis was carried out for the indicators with statistical differences in the conclusions of the above control study. Subgroup analysis was carried out and the samples were divided into four subgroups according to gender,age, initial ejection fraction . Resulst: one month after the treatment of sacubitril/valsartan or benalapril, only the left ventricular end systolic diameter was statistically different between the two groups (P < 0.05), and the other indexes were not statistically different. Three months after treatment with sacubitril/valsartan or benalapril, there were statistical differences in the indexes related to myocardial remodeling between the two groups (P < 0.05). The results of multivariate logistic analysis showed that the index of left ventricular end systolic diameter was statistically significant (or=0.006, 95% CI: 0.733-0.981). Acute myocardial infarction whose LVEF is less than 50%, show sacubitril/valsartan is better than traditional ACEI. Conclusion: sacubitril/valsartan Compared with benalapril is better on left ventricular remodeling in patients with ST segment elevation acute myocardial infarction.
Highlights
Chronic heart failure is the end stage of many cardiovascular diseases
Left ventricular remodeling is characterized by a progressive increase in both end-diastolic (LVEDV) and end-systolic volumes (LVESV)
Infarcted wall usually has longer contraction times than the healthy myocardium. This wall motion defect has been recognized as a risk factor for the development of remodeling, and it can be assessed with echocardiography or cine CMR to maintain a normal stoke volume with a reduced number of normally working myocardial segments, the healthy myocardium has to produce a greater pressure[2,3]
Summary
Chronic heart failure is the end stage of many cardiovascular diseases. Development of the HF phenotype in these patients arise from a complex, progressive, molecular and cellular transformation references “ventricular remodeling”, includes dilation of the ventricle, the formation of scar and geometrical charges in the overall left ventricle(LV) shape (i e, ellipsoid to more spherical) and is driven, in part by neurohormonal pathways. Left ventricular remodeling is characterized by a progressive increase in both end-diastolic (LVEDV) and end-systolic volumes (LVESV). The increase in LVESV can precede the increase in LVEDV, as a consequence of an impaired systolic function that causes a reduction in stroke volume. Post infarct remodeling is a specific type of left ventricular remodeling that is a consequence of an increase in both preload and afterload causing an enlargement of ventricular chamber and a hypertrophy of normal myocardium. Anggiotensin II (Ang II) can promote the occurrence and development of ventricular remodeling in patients with cardiac insufficiency. To compare the effect of sacubitril/valsartan with benalapril on left ventricular remodeling in patients with acute myocardial infarction
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