Abstract:
Objective To explore the therapeutic efficacy of sacubitril/valsartan （S/V）, a representative drug of angiotensin receptor enkephalinase inhibitors （ARNI）, in patients with different types of left ventricular ejection fraction （LVEF） heart failure （HF） on maintenance hemodialysis （MHD）.
Methods From June 1, 2022 to May 31, 2023, 155 MHD patients with concurrent HF continuously taking S/V for more than 3 months were selected. According to the level of LVEF, they were assigned into three groups of HF with reduced ejection fraction（HFrEF, n=41）, HF with mid-range ejection fraction（HFmrEF, n=42） and HF with preserved ejection fraction（HFmrEF, n=2）. Heart rate （HR）, blood pressure （BP）, hemoglobin （Hb）, Potassium （K+）, uric acid （UA）, estimated glomerular filtration rate （eGFR）, creatinine （Cr）, brain natriuretic peptide （BNP） and echocardiographic findings before and after dosing were retrospectively reviewed.
Results After drug dosing, overall population HR 78.0（71.0, 89.0） beats/min vs 82.0（73.0, 95.0） beats/min, systolic blood pressure138.0（123.0, 158.0） mmHg vs 155.0（139.0, 173.0） mmHg（1 mmHg=0.133 kPa）, diastolic blood pressure78.0（68.0, 90.0） mmHg vs 90.0（76.0, 100.0） mmHg, BNP level729.6（234.9, 1942.2） pg/ml vs 2562.7（928.9, 4957.1） pg/ml and interventricular septal thickness12.0（11.0, 13.0）mm vs 13.0（12.0, 14.0） mm were lower than those pre-treatment（all P＜0.05）; LVEF was higher than pre-dosing 58.0（51.0. 61.0）% vs 49.0（40.0, 56.0）%（P＜0.05）. The difference in proportional distribution of New York Heart Association （NYHA） cardiac function class before and after drug administration was statistically significant（P＜0.05）. In HFrEF group, heart rate81.0（70.0, 100.0） beats/min vs 94.0（75.5, 110.0） beats/min, systolic blood pressure 130.0（118.0, 152.0）mmHg vs 146.0（128.0, 166.0） mmHg, diastolic blood pressure 80.0（63.5, 89.0）mmHg vs 79.0（72.0, 96.0）mmHg, BNP1366.9（612.0, 2991.4） pg/ml vs 4294.9（2562.3, 5000.0） pg/ml and ventricular septal thickness12.0（11.0, 13.0）mm vs 13.0（11.0, 11.0, 14.0） mm lower than pre-dosing （all P＜0.05）; LVEF was higher post-dosing than pre-dosing48.0（42.5, 55.0）% vs 36.0（32.0, 39.0）%（P＜0.05）. HFmrEF group had a higher post-dosing HR75.0（68.8, 80.3）beats/min vs 80.5（75.0, 95.0）beats/min, systolic blood pressure138.0（121.8, 159.0）mmHg vs 158.0（139.0, 181.3）mmHg, diastolic blood pressure78.0（67.0, 91.3）mmHg vs 92.0（79.8, 104.8）mmHg, BNP765.5（245.1, 2323.2）pg/ml vs 3179.7（1325.2, 4967.8）pg/ml and interventricular septal thickness12.0（11.0, 13.0）mm vs 13.0（12.0, 14.0）mm declined as compared with pre-dosing （all P＜0.05）; LVEF was significantly higher after dosing54.5（50.8, 60.0）% vs 47.0（44.0, 48.0）%（P＜0.05）. In HFpEF group, systolic blood pressure139.0（129.3, 161.0）mmHg vs 161.5（146.3, 173.8）mmHg, diastolic blood pressure77.0（70.0, 91.0）mmHg vs 90.5（78.0, 99.8）mmHg, BNP433.5（171.4, 1237.8）pg/ml vs 1109.0（651.9, 2772.5）pg/ml and thickness of interventricular septum12.0（11.0, 12.0）mm vs 13.0（12.0, 14.0）mm were lower than pre-dosing （all P＜0.05）. LVEF rose obviously post-dosing 60.0（59.0, 65.0）% vs 56.0（54.0, 60.0）%（P＜0.05）. The differences in K+, eGFR and UA levels before and after dosing were not statistically significant among HFrEF, HFmrEF and HFpEF groups （P＞0.05）.
Conclusion S/V has been shown to lower HR, lower BR, improve HF, lessen septal hypertrophy and enhance myocardial contractility in MHD patients with different types of LVEF HF.
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