Coronary heart disease and type 2 diabetes mellitus(T2DM)often co-occur,presenting substantial health risks,particularly following acute myocardial infarction(AMI).While percutaneous coronary intervention(PCI)is a pre...Coronary heart disease and type 2 diabetes mellitus(T2DM)often co-occur,presenting substantial health risks,particularly following acute myocardial infarction(AMI).While percutaneous coronary intervention(PCI)is a prevalent treatment,complications such as microvascular dysfunction may lead to heart failure,necessitating additional therapies.This editorial examines the emerging roles of sacubitril/valsartan and sodium-glucose co-transporter 2 inhibitors in managing post-PCI.Recent research investigates the combined effects of dapag-liflozin and telmisartan on myocardial microperfusion in post-AMI heart failure patients with T2DM.The findings suggest that this combination enhances myo-cardial microcirculation,improves cardiac function,and achieves better glycemic control,with a reduced incidence of major adverse cardiovascular events.Despite ongoing challenges,the integration of dapagliflozin and sacubitril/valsartan re-presents a significant advancement in post-AMI care.Further investigation in larger cohorts and more diverse patient populations is required to confirm its long-term clinical outcomes.展开更多
[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STE...[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STEMI patients(qi and yin deficiency and blood stasis and obstruction)hospitalized in Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2020 to June 2021 were randomly divided into 21 cases in the treatment group and 20 cases in the control group,and the two groups were given standardized Western medicine treatment as soon as possible after PCI.The control group was treated with Sacubitril Valsartan,and the treatment group was treated with Guanxin-V Mixture on the basis of treatment in the control group.The patients in the two groups were treated for 3 months,and the TCM syndrome score,left ventricular ejection fraction(LVEF),and N-Terminal Pro-Brain Natriuretic Peptide(NT-proBNP),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels,and the incidence of heart failure and adverse reactions in the two groups after treatment were recorded.[Results]After the treatment,the TCM syndrome score and serum NT-proBNP,IL-6 and hs-CRP levels of the two groups significantly decreased(P<0.05),and the levels of the treatment group were significantly lower than those of the control group(P<0.05);the LVEF of the two groups significantly increased(P<0.05),and the level of the treatment group was significantly higher than that of the control group(P<0.05).Comparison of the incidence of heart failure and adverse reactions in the two groups showed no statistically significant differences(P>0.05).[Conclusions]Guanxin-V Mixture combined with Sacubitril Valsartan could significantly improve cardiac function in STEMI patients undergoing PCI,and its effect may be related to the suppression of inflammatory response.展开更多
Objective:To systematically evaluate the clinical efficacy of oral Chinese patent medicine combined with sacubitril/valsartan in treating chronic heart failure(CHF).Methods:CNKI,CSPD,CCD,CBM,PubMed,Web of Science,Coch...Objective:To systematically evaluate the clinical efficacy of oral Chinese patent medicine combined with sacubitril/valsartan in treating chronic heart failure(CHF).Methods:CNKI,CSPD,CCD,CBM,PubMed,Web of Science,Cochrane Library and EMbase were retrieved to screen out randomized controlled trials Chinese patent medicine and Western medicine in treating CHF.Manual retrieval was also applied as a supplement.The Cochrane Reviewers Handbook 5.1.0 was used to evaluate the bias risk of the included studies and RevMan 5.4 software was used for Meta-analysis.Results:A total of 1301 patients enrolled in the 13 RCTs were included.According to the results of Meta-analysis,a combination of oral Chinese patent medicine and sacubitril/valsartan could further improve total effectiveness rate(RR=1.23,95%CI[1.16,1.30],P<0.001),increase 6 minutes’walk distance(MD=53.04,95%CI[33.43,72.64],P<0.001),improve left ventricular ejection fraction(MD=6.67,95%CI[5.15,8.19],P<0.001)and stroke volume(MD=7.56,95%CI[3.94,11.18],P<0.001),reduce left ventricular end-diastolic dimension(MD=-3.68,95%CI[-4.57,-2.78],P<0.001)and N terminal pro B type natriuretic peptide(MD=-434.08,95%CI[-518.95,-349.22],P<0.001)and no statistically significant difference in drug safety was found between the sacubitril/valsartan-only group and the combined treatment group(RR=0.73,95%CI[0.32,1.65],P=0.45).Conclusion:It’s indicated that a combination of traditional Chinese patent medicine and sacubitril/valsartan had a good clinical efficacy in the treatment of CHF,which had certain guiding significance for clinical practice.展开更多
Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for...Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the fast in class angiotensin receptor neprilysin inhibitor （ARNI） since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin Ⅱ receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides （NPs）, bradykinin, endothelin and angiotensin II （Ang-II）. Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-Ⅱ （with opposite biological actions）. So, a combined inhibition of these both systems （Sacubitril / valsartan） may enhance the benefits of NPs effects in HF （natriuresis, diuresis, etc） while Ang-Ⅱ receptor is inhibited （reducing vasoconstriction and aldosterone release）. In a large clinical trial （PARADIGM-HF with 8442 patients）, this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF （compared to enalapril）. This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction.展开更多
BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness pr...BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness progressively develops in DMD patients and usually leads to respiratory failure in the early adolescent years.Cardiac muscle is frequently affected in DMD patients,which leads to a high burden of cardiomyopathy and heart failure.In the era of improved respiratory care,cardiac deaths are becoming the major cause of mortality in DMD patients.CASE SUMMARY We report the case of a 15-year-old boy who presented to the hospital due to recurrent orthopnea for 6 mo and palpitations for 4 mo.He was diagnosed with progressive muscular dystrophy at the age of 3 years and was confined to a wheelchair at 12 years.He was prescribed diuretics and digoxin at the outpatient clinic;however,his symptoms did not resolve.Sacubitril/valsartan was added 1 mo prior to presentation,but he experienced recurrent episodes of palpitations.The electrocardiogram showed atrial tachycardia with a heart rate of 201 bpm,and he was then hospitalized.Hypotension was found following the administration of sacubitril/valsartan tablets;he could not tolerate even a small dose,always developing tachyarrhythmia.His symptoms were relieved after discontinuing sacubitril/valsartan,and his heart rate was controlled by a small dose of metoprolol tartrate and digoxin.Atrial tachycardia spontaneously converted in this patient,and his symptoms attenuated in the following 6 mo,without palpitation episodes.CONCLUSION Blood pressure should be closely monitored in DMD patients with advanced heart failure when taking sacubitril/valsartan.展开更多
1 Introduction Sacubitril/valsartan(SV)is a first in class dual action molecule of the neprilysin(NEP)inhibitor prodrug sacubitril(AHU377)and the angiotensin II receptor(Ang-II)type 1 antagonist valsartanJ11 It is the...1 Introduction Sacubitril/valsartan(SV)is a first in class dual action molecule of the neprilysin(NEP)inhibitor prodrug sacubitril(AHU377)and the angiotensin II receptor(Ang-II)type 1 antagonist valsartanJ11 It is the first angiotensin receptor-neprilysin inhibitor(ARNI)whose pharmacodynamic effects are consistent with a simultaneous stimulation of the natriuretic peptides system(via NEP inhibition)and the blockade of the renin-angiotensin-aldosterone system(valsartan effect)that finally results in systemic vasodilation,increased diuresis and natriuresis,reduction of plasmatic volume and diminution of peripheral vascular resistance.展开更多
Objective: To investigate the effect of sacubitril-valsartan combined with Zhenyuan capsule in the treatment of chronic heart failure comorbid anxiety and depression and its effect on the level of inflammatory factors...Objective: To investigate the effect of sacubitril-valsartan combined with Zhenyuan capsule in the treatment of chronic heart failure comorbid anxiety and depression and its effect on the level of inflammatory factors. Methods: A total of 106 patients with chronic heart failure comorbid anxiety and depression from February 2020 to March 2022 were continuously enrolled and divided into control group (36 cases), observation group A (36 cases) and observation group B (34 cases) according to treatment methods. All groups were given conventional treatment. On the basis of routine treatment, the control group, observation group A and observation group B were given valsartan, sacubitril-valsartan and sacubitril-valsartan plus Zhenyuan Capsules for the treatment of consecutive 8 weeks. The patients in the 3 groups were evaluated by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before and after treatment, and the clinical efficacy of heart failure was evaluated, and the detection of left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), N terminal brain natriuretic peptide (NT-proBNP), tumor necrosis factor alpha (TNF alpha), interleukin 6 (IL-6), c-reactive protein (CRP) was conducted. Results: The clinical efficacy rate and total effective rate of heart failure in observation group A and observation group B were significantly higher than those in the control group (P < 0.05), and the observation group B was higher than the observation group A (P < 0.05);SAS and SDS scores in observation group A and observation group B were significantly lower than the control group (P < 0.05), and observation group B was lower than observation group A (P < 0.05);The LVEF in the three groups was all increased compared with those before treatment, and the levels of LVESD, LVEDD, NT-proBNP, TNF-α, IL-6, and hs-CRP were all decreased compared with those before treatment;The changes of above indexes in observation group A and observation group B were more significant than those in control group (P < 0.05). Except for the LVEDD index, the observation group B had significant changes compared with the observation group A (P < 0.05). Conclusion: Sacubitril valsartan can improve cardiac function, reduce inflammatory response, and improve anxiety and depression in patients with chronic heart failure, and the treatment effect of combination with Zhenyuan Capsule is more significant.展开更多
Objective:To systematically review the effect of Sacubitril valsartan combined with Qiliqiangxincapsule on clinical effect,serological index,cardiac function,quality of live,and adverse reactions in patients with hear...Objective:To systematically review the effect of Sacubitril valsartan combined with Qiliqiangxincapsule on clinical effect,serological index,cardiac function,quality of live,and adverse reactions in patients with heart failure.Methods:Search the databases of CNKI,VIP,WanFang,CBM,DuXiu,ChiCTR,Web of science,The Cochrane Library,PubMed and Embase to collect the randomized controlled trial(RCT)of Sacubitril valsartan combined with Qiliqiangxin capsule in the treatment of patients with heart failure,The search time limit is from the establishment of the database to May 2021.After the literatures were screened,evaluated and extracted by two researchers independently,Meta analysis was carried out with Stata 16.1 software.Results:A total of 18 RCTs,were included,including 1613 patients.The results of the Meta-analysis showed that there was statistical significance in improving the effective rate(OR=2.60,95%CI[2.09,3.24],P<0.00001),N-terminal pro-brain natriuretic peptide(MD=-468.36,95%CI[-606.80,-329.92],P<0.00001),left ventricular ejection fraction(MD=5.41,95%CI[4.93,5.89],P<0.00001),left ventricular end-diastolic diameter(MD=-3.27,95%CI[-3.65,-2.90],P<0.00001),left ventricular end-systolic diameter(MD=-3.60,95%CI[-4.99,-2.21],P<0.00001),6-minute walking distance(MD=61.42,95%CI[50.04,72.80],P<0.00001),Minnesota living with heart failure questionnaire(MD=-11.39,95%CI[-14.50,-8.28],P<0.00001),and traditional Chinese medicine syndrome score scale(MD=-3.62,95%CI[-6.45,-0.80],P=0.01),but there was no significant difference in cardiac output(MD=0.26,95%CI[-0.02,0.54],P=0.07)and adverse reactions.Conclusion:The current evidence shows that Sacubitril Valsartan combined with Qiliqiangxin capsule can better improve cardiac function,TCM symptoms and quality of life in patients with heart failure than simple Sacubitril Valsartan.However,there was no significantdifference in improving cardiac output between the two groups.However,higher quality RCTs are needed to verify.展开更多
1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was ...1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was considered to be a risk equivalent of coronary heart disease.[1,2]Adjusted for confounders,decreased glomerular filtration rate(GFR)and increased albuminuria are both independent risk factors for cardiovascular events.[3,4]The risk for cardiovascular death linearly increases with the decline of GFR in a certain range(<70 mL/min per 1.73 m^2)and the increase of albuminuria without a threshold effect[3].展开更多
Objective:To investigate the effects of sacubitril/valsartan on the expression of Galectin-3 (Gal-3) and Matrix metalloproteinase-9 (MMP-9) in New Zealand rabbits with stress-induced cardiac hypertrophy.Methods: Twent...Objective:To investigate the effects of sacubitril/valsartan on the expression of Galectin-3 (Gal-3) and Matrix metalloproteinase-9 (MMP-9) in New Zealand rabbits with stress-induced cardiac hypertrophy.Methods: Twenty-four healthy male 8-week-old New Zealand rabbits were randomly divided into sham operation group (Sham), model group (Model), and sacubitril/valsartan group (Sacu/Vals), with 8 rats in each group. Abdominal aortic coarctation was used to construct a model of cardiac hypertrophy. After 8 weeks of successful modeling, the acubitril/valsartan group was administered with the drug, and the other two groups were given an equal volume of normal saline. All rabbit hearts were sacrificed at the end of the 16th week. The left ventricular mass index and the whole heart mass index were measured. The left ventricular myocardial tissue was evaluated by HE staining to evaluate the cardiac hypertrophy. The expression of Gal-3 and MMP-9 in the myocardial tissue was detected by western blot.Results: (1) Compared with the sham operation group, the HMI and LVMI of the model group and the sacubitril/valsartan group increased. Compared with the model group, the HBA and LVMI decreased in the sacubitril/valsartan group;(2) In the sham operation group, the myocardial fibers were arranged neatly, arranged in a bundle, and the morphology was intact, and no obvious fibrous tissue was observed. The myocardial fibers in the model group were disordered, most of them were broken, the cells were edematous, and the myocardial interstitial showed fibrous connective tissue. Compared with the model group, the sacubitril/valsartan group had a neat arrangement of myocardial fibers and a significant reduction in cell edema;(3) Compared with sham operation, the expression of Gal-3 and MMP-9 protein in the model group and the sacubitril/valsartan group increased;compared with the model group, sacubitril/valsartan the expression levels of Gal-3 and MMP-9 in the tan group were decreased.Conclusion: Sacubitril/valsartan can alleviate cardiac hypertrophy in rabbits, and its mechanism may be related to down-regulation of Gal-3 and MMP-9 protein expression.展开更多
Objective:To study the influence of sacubitril/valsartan on plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 levels in patients with heart failure. Methods: To choose 42 cases of chronic he...Objective:To study the influence of sacubitril/valsartan on plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 levels in patients with heart failure. Methods: To choose 42 cases of chronic heart failure in our hospital form August 2017 to December 2017 as the study group, and 42 cases of chronic heart failure form January 2017 to June 2017 as the control group. The patients in the control group were treated with 80 mg valsartan on the basis of general treatment, 1 times a day, and the patients in the study group were added with 50mg sacubitril/valsartan on the basis of general treatment, 2 times a day. To compare the plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 levels before and after treatment in the two groups.Results:Before treatment, there was no statistical difference between the levels of plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 in the two groups;(1) After treatment, the levels of plasma NE, AngⅡ, ALD in the control group compared with those before treatment in the seme group, there were significant differences, and there were significant differences between the two groups;(2) After treatment, the levels of serum sCD40L, sICAM-1, sFas, sFasL in the control group compared with those before treatment in the same group, there were significant differences, and there were significant differences between the two groups;(3) After treatment, the levels of serum cTnI, MMP-9 in the control group compared with those before treatment in the seme group, there were significant differences, and there were significant differences between the two groups.Conclusion: The application of sacubitril/valsartan to patients with heart failure on the basis of general treatment, not only could significantly improve the levels of plasma NE, AngⅡ, ALD, and also could significantly improve the levels of serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9, the curative effect was more significant, it was worthy for clinical research and application.展开更多
Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontradit...Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontraditional vascular risk factors, unique to the milieu of chronic kidney disease and the dialysis modality<a href="#ref1"> [1]</a>. The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an ESRD patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF). A 35-year-old woman was undergoing hemodialysis due to ESRD and suffering from heart failure with reduced ejection fraction. Because of worsening heart failure and hypertension, she was prescribed with sacubitril/valsartan at a dose of 50 mg twice a day, spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily. There was a symptomatic improvement with the heart failure and reduction in NT-proBNP level, accompanied by a decrease of blood pressure after using sacubitric/valsartan. In conclusion, it is safe and effective to take sacubitril/valsartan in this hemodialysis patient with severe heart failure.展开更多
基金Supported by the Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine,No.2022ZYYJ01Guangzhou Municipal Science and Technology Bureau's 2024 Basic and Applied Basic Research Topic,No.2024A04J4254.
文摘Coronary heart disease and type 2 diabetes mellitus(T2DM)often co-occur,presenting substantial health risks,particularly following acute myocardial infarction(AMI).While percutaneous coronary intervention(PCI)is a prevalent treatment,complications such as microvascular dysfunction may lead to heart failure,necessitating additional therapies.This editorial examines the emerging roles of sacubitril/valsartan and sodium-glucose co-transporter 2 inhibitors in managing post-PCI.Recent research investigates the combined effects of dapag-liflozin and telmisartan on myocardial microperfusion in post-AMI heart failure patients with T2DM.The findings suggest that this combination enhances myo-cardial microcirculation,improves cardiac function,and achieves better glycemic control,with a reduced incidence of major adverse cardiovascular events.Despite ongoing challenges,the integration of dapagliflozin and sacubitril/valsartan re-presents a significant advancement in post-AMI care.Further investigation in larger cohorts and more diverse patient populations is required to confirm its long-term clinical outcomes.
基金Supported by National Natural Science Foundation of China(81774229)Nanjing Chinese Medicine Young Talent Cultivation Program(ZYQ20027)+3 种基金Natural Science Foundation of Nanjing University of Chinese Medicine(XZR2021052)Discipline(Academic)Reserve Talent Training Program of Nanjing Hospital of Chinese Medicine(YRC2016-CZL)Nanjing Traditional Chinese Medicine Science and Technology Special Fund Project(ZYQN202203)Traditional Chinese Medicine Preparation Research Project in Nanjing Medical Institutions(NJCC-ZJ-202315).
文摘[Objectives]To observe the effect of Guanxin-V Mixture combined with Sacubitril Valsartan on cardiac function in patients after PCI for acute ST-segment elevation myocardial infarction(STE-MI).[Methods]41 cases of STEMI patients(qi and yin deficiency and blood stasis and obstruction)hospitalized in Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine from January 2020 to June 2021 were randomly divided into 21 cases in the treatment group and 20 cases in the control group,and the two groups were given standardized Western medicine treatment as soon as possible after PCI.The control group was treated with Sacubitril Valsartan,and the treatment group was treated with Guanxin-V Mixture on the basis of treatment in the control group.The patients in the two groups were treated for 3 months,and the TCM syndrome score,left ventricular ejection fraction(LVEF),and N-Terminal Pro-Brain Natriuretic Peptide(NT-proBNP),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels,and the incidence of heart failure and adverse reactions in the two groups after treatment were recorded.[Results]After the treatment,the TCM syndrome score and serum NT-proBNP,IL-6 and hs-CRP levels of the two groups significantly decreased(P<0.05),and the levels of the treatment group were significantly lower than those of the control group(P<0.05);the LVEF of the two groups significantly increased(P<0.05),and the level of the treatment group was significantly higher than that of the control group(P<0.05).Comparison of the incidence of heart failure and adverse reactions in the two groups showed no statistically significant differences(P>0.05).[Conclusions]Guanxin-V Mixture combined with Sacubitril Valsartan could significantly improve cardiac function in STEMI patients undergoing PCI,and its effect may be related to the suppression of inflammatory response.
基金National Natural Science Foundation of China (No.81803925)National Key Research and Development Program (No.2017YFC1700102)。
文摘Objective:To systematically evaluate the clinical efficacy of oral Chinese patent medicine combined with sacubitril/valsartan in treating chronic heart failure(CHF).Methods:CNKI,CSPD,CCD,CBM,PubMed,Web of Science,Cochrane Library and EMbase were retrieved to screen out randomized controlled trials Chinese patent medicine and Western medicine in treating CHF.Manual retrieval was also applied as a supplement.The Cochrane Reviewers Handbook 5.1.0 was used to evaluate the bias risk of the included studies and RevMan 5.4 software was used for Meta-analysis.Results:A total of 1301 patients enrolled in the 13 RCTs were included.According to the results of Meta-analysis,a combination of oral Chinese patent medicine and sacubitril/valsartan could further improve total effectiveness rate(RR=1.23,95%CI[1.16,1.30],P<0.001),increase 6 minutes’walk distance(MD=53.04,95%CI[33.43,72.64],P<0.001),improve left ventricular ejection fraction(MD=6.67,95%CI[5.15,8.19],P<0.001)and stroke volume(MD=7.56,95%CI[3.94,11.18],P<0.001),reduce left ventricular end-diastolic dimension(MD=-3.68,95%CI[-4.57,-2.78],P<0.001)and N terminal pro B type natriuretic peptide(MD=-434.08,95%CI[-518.95,-349.22],P<0.001)and no statistically significant difference in drug safety was found between the sacubitril/valsartan-only group and the combined treatment group(RR=0.73,95%CI[0.32,1.65],P=0.45).Conclusion:It’s indicated that a combination of traditional Chinese patent medicine and sacubitril/valsartan had a good clinical efficacy in the treatment of CHF,which had certain guiding significance for clinical practice.
文摘Despite significant therapeutic advances, patients with chronic heart failure （HF） remain at high risk of morbidity and mortality. Sacubitill valsartan （previously known as LCZ696） is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the fast in class angiotensin receptor neprilysin inhibitor （ARNI） since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin Ⅱ receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides （NPs）, bradykinin, endothelin and angiotensin II （Ang-II）. Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-Ⅱ （with opposite biological actions）. So, a combined inhibition of these both systems （Sacubitril / valsartan） may enhance the benefits of NPs effects in HF （natriuresis, diuresis, etc） while Ang-Ⅱ receptor is inhibited （reducing vasoconstriction and aldosterone release）. In a large clinical trial （PARADIGM-HF with 8442 patients）, this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF （compared to enalapril）. This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction.
基金Natural Science Foundation of Zhejiang Province,No.LQ16H020004
文摘BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness progressively develops in DMD patients and usually leads to respiratory failure in the early adolescent years.Cardiac muscle is frequently affected in DMD patients,which leads to a high burden of cardiomyopathy and heart failure.In the era of improved respiratory care,cardiac deaths are becoming the major cause of mortality in DMD patients.CASE SUMMARY We report the case of a 15-year-old boy who presented to the hospital due to recurrent orthopnea for 6 mo and palpitations for 4 mo.He was diagnosed with progressive muscular dystrophy at the age of 3 years and was confined to a wheelchair at 12 years.He was prescribed diuretics and digoxin at the outpatient clinic;however,his symptoms did not resolve.Sacubitril/valsartan was added 1 mo prior to presentation,but he experienced recurrent episodes of palpitations.The electrocardiogram showed atrial tachycardia with a heart rate of 201 bpm,and he was then hospitalized.Hypotension was found following the administration of sacubitril/valsartan tablets;he could not tolerate even a small dose,always developing tachyarrhythmia.His symptoms were relieved after discontinuing sacubitril/valsartan,and his heart rate was controlled by a small dose of metoprolol tartrate and digoxin.Atrial tachycardia spontaneously converted in this patient,and his symptoms attenuated in the following 6 mo,without palpitation episodes.CONCLUSION Blood pressure should be closely monitored in DMD patients with advanced heart failure when taking sacubitril/valsartan.
文摘1 Introduction Sacubitril/valsartan(SV)is a first in class dual action molecule of the neprilysin(NEP)inhibitor prodrug sacubitril(AHU377)and the angiotensin II receptor(Ang-II)type 1 antagonist valsartanJ11 It is the first angiotensin receptor-neprilysin inhibitor(ARNI)whose pharmacodynamic effects are consistent with a simultaneous stimulation of the natriuretic peptides system(via NEP inhibition)and the blockade of the renin-angiotensin-aldosterone system(valsartan effect)that finally results in systemic vasodilation,increased diuresis and natriuresis,reduction of plasmatic volume and diminution of peripheral vascular resistance.
文摘Objective: To investigate the effect of sacubitril-valsartan combined with Zhenyuan capsule in the treatment of chronic heart failure comorbid anxiety and depression and its effect on the level of inflammatory factors. Methods: A total of 106 patients with chronic heart failure comorbid anxiety and depression from February 2020 to March 2022 were continuously enrolled and divided into control group (36 cases), observation group A (36 cases) and observation group B (34 cases) according to treatment methods. All groups were given conventional treatment. On the basis of routine treatment, the control group, observation group A and observation group B were given valsartan, sacubitril-valsartan and sacubitril-valsartan plus Zhenyuan Capsules for the treatment of consecutive 8 weeks. The patients in the 3 groups were evaluated by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before and after treatment, and the clinical efficacy of heart failure was evaluated, and the detection of left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), N terminal brain natriuretic peptide (NT-proBNP), tumor necrosis factor alpha (TNF alpha), interleukin 6 (IL-6), c-reactive protein (CRP) was conducted. Results: The clinical efficacy rate and total effective rate of heart failure in observation group A and observation group B were significantly higher than those in the control group (P < 0.05), and the observation group B was higher than the observation group A (P < 0.05);SAS and SDS scores in observation group A and observation group B were significantly lower than the control group (P < 0.05), and observation group B was lower than observation group A (P < 0.05);The LVEF in the three groups was all increased compared with those before treatment, and the levels of LVESD, LVEDD, NT-proBNP, TNF-α, IL-6, and hs-CRP were all decreased compared with those before treatment;The changes of above indexes in observation group A and observation group B were more significant than those in control group (P < 0.05). Except for the LVEDD index, the observation group B had significant changes compared with the observation group A (P < 0.05). Conclusion: Sacubitril valsartan can improve cardiac function, reduce inflammatory response, and improve anxiety and depression in patients with chronic heart failure, and the treatment effect of combination with Zhenyuan Capsule is more significant.
文摘Objective:To systematically review the effect of Sacubitril valsartan combined with Qiliqiangxincapsule on clinical effect,serological index,cardiac function,quality of live,and adverse reactions in patients with heart failure.Methods:Search the databases of CNKI,VIP,WanFang,CBM,DuXiu,ChiCTR,Web of science,The Cochrane Library,PubMed and Embase to collect the randomized controlled trial(RCT)of Sacubitril valsartan combined with Qiliqiangxin capsule in the treatment of patients with heart failure,The search time limit is from the establishment of the database to May 2021.After the literatures were screened,evaluated and extracted by two researchers independently,Meta analysis was carried out with Stata 16.1 software.Results:A total of 18 RCTs,were included,including 1613 patients.The results of the Meta-analysis showed that there was statistical significance in improving the effective rate(OR=2.60,95%CI[2.09,3.24],P<0.00001),N-terminal pro-brain natriuretic peptide(MD=-468.36,95%CI[-606.80,-329.92],P<0.00001),left ventricular ejection fraction(MD=5.41,95%CI[4.93,5.89],P<0.00001),left ventricular end-diastolic diameter(MD=-3.27,95%CI[-3.65,-2.90],P<0.00001),left ventricular end-systolic diameter(MD=-3.60,95%CI[-4.99,-2.21],P<0.00001),6-minute walking distance(MD=61.42,95%CI[50.04,72.80],P<0.00001),Minnesota living with heart failure questionnaire(MD=-11.39,95%CI[-14.50,-8.28],P<0.00001),and traditional Chinese medicine syndrome score scale(MD=-3.62,95%CI[-6.45,-0.80],P=0.01),but there was no significant difference in cardiac output(MD=0.26,95%CI[-0.02,0.54],P=0.07)and adverse reactions.Conclusion:The current evidence shows that Sacubitril Valsartan combined with Qiliqiangxin capsule can better improve cardiac function,TCM symptoms and quality of life in patients with heart failure than simple Sacubitril Valsartan.However,there was no significantdifference in improving cardiac output between the two groups.However,higher quality RCTs are needed to verify.
基金the National Key Research and Development Programme of China(2018YFC1314003)the Education of Zhejiang Province(Y201328620).
文摘1 Introduction Chronic kidney disease(CKD)often coexists with or is a complication of cardiovascular disease.Previous studies have shown that CKD increases the risk of cardiovascular death and all-cause death and was considered to be a risk equivalent of coronary heart disease.[1,2]Adjusted for confounders,decreased glomerular filtration rate(GFR)and increased albuminuria are both independent risk factors for cardiovascular events.[3,4]The risk for cardiovascular death linearly increases with the decline of GFR in a certain range(<70 mL/min per 1.73 m^2)and the increase of albuminuria without a threshold effect[3].
文摘Objective:To investigate the effects of sacubitril/valsartan on the expression of Galectin-3 (Gal-3) and Matrix metalloproteinase-9 (MMP-9) in New Zealand rabbits with stress-induced cardiac hypertrophy.Methods: Twenty-four healthy male 8-week-old New Zealand rabbits were randomly divided into sham operation group (Sham), model group (Model), and sacubitril/valsartan group (Sacu/Vals), with 8 rats in each group. Abdominal aortic coarctation was used to construct a model of cardiac hypertrophy. After 8 weeks of successful modeling, the acubitril/valsartan group was administered with the drug, and the other two groups were given an equal volume of normal saline. All rabbit hearts were sacrificed at the end of the 16th week. The left ventricular mass index and the whole heart mass index were measured. The left ventricular myocardial tissue was evaluated by HE staining to evaluate the cardiac hypertrophy. The expression of Gal-3 and MMP-9 in the myocardial tissue was detected by western blot.Results: (1) Compared with the sham operation group, the HMI and LVMI of the model group and the sacubitril/valsartan group increased. Compared with the model group, the HBA and LVMI decreased in the sacubitril/valsartan group;(2) In the sham operation group, the myocardial fibers were arranged neatly, arranged in a bundle, and the morphology was intact, and no obvious fibrous tissue was observed. The myocardial fibers in the model group were disordered, most of them were broken, the cells were edematous, and the myocardial interstitial showed fibrous connective tissue. Compared with the model group, the sacubitril/valsartan group had a neat arrangement of myocardial fibers and a significant reduction in cell edema;(3) Compared with sham operation, the expression of Gal-3 and MMP-9 protein in the model group and the sacubitril/valsartan group increased;compared with the model group, sacubitril/valsartan the expression levels of Gal-3 and MMP-9 in the tan group were decreased.Conclusion: Sacubitril/valsartan can alleviate cardiac hypertrophy in rabbits, and its mechanism may be related to down-regulation of Gal-3 and MMP-9 protein expression.
基金Funded Project of Hebei Natural Science Foundation(H2016102348).
文摘Objective:To study the influence of sacubitril/valsartan on plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 levels in patients with heart failure. Methods: To choose 42 cases of chronic heart failure in our hospital form August 2017 to December 2017 as the study group, and 42 cases of chronic heart failure form January 2017 to June 2017 as the control group. The patients in the control group were treated with 80 mg valsartan on the basis of general treatment, 1 times a day, and the patients in the study group were added with 50mg sacubitril/valsartan on the basis of general treatment, 2 times a day. To compare the plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 levels before and after treatment in the two groups.Results:Before treatment, there was no statistical difference between the levels of plasma NE, AngⅡ, ALD and serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9 in the two groups;(1) After treatment, the levels of plasma NE, AngⅡ, ALD in the control group compared with those before treatment in the seme group, there were significant differences, and there were significant differences between the two groups;(2) After treatment, the levels of serum sCD40L, sICAM-1, sFas, sFasL in the control group compared with those before treatment in the same group, there were significant differences, and there were significant differences between the two groups;(3) After treatment, the levels of serum cTnI, MMP-9 in the control group compared with those before treatment in the seme group, there were significant differences, and there were significant differences between the two groups.Conclusion: The application of sacubitril/valsartan to patients with heart failure on the basis of general treatment, not only could significantly improve the levels of plasma NE, AngⅡ, ALD, and also could significantly improve the levels of serum sCD40L, sICAM-1, sFas, sFasL and cTnI, MMP-9, the curative effect was more significant, it was worthy for clinical research and application.
文摘Heart failure (HF) is a major comorbidity in patients with end-stage renal disease (ESRD). The pathogenesis of HF in patients on renal replacement therapy represents the confluence of several traditional and nontraditional vascular risk factors, unique to the milieu of chronic kidney disease and the dialysis modality<a href="#ref1"> [1]</a>. The purpose of this report is to describe the efficacy and safety of sacubitril/valsartan for an ESRD patient on hemodialysis therapy conmbined with heart failure with reduced ejection fraction (HFrEF). A 35-year-old woman was undergoing hemodialysis due to ESRD and suffering from heart failure with reduced ejection fraction. Because of worsening heart failure and hypertension, she was prescribed with sacubitril/valsartan at a dose of 50 mg twice a day, spironolactone at a dose of 20 mg three times a day and metoprolol at a dose of 23.75 mg once daily. There was a symptomatic improvement with the heart failure and reduction in NT-proBNP level, accompanied by a decrease of blood pressure after using sacubitric/valsartan. In conclusion, it is safe and effective to take sacubitril/valsartan in this hemodialysis patient with severe heart failure.
