The Effect of Sacubitril/Valartan on Cardiac Remodeling in Maintenance Hemodialysis Patients with Heart Failure with Preserved Ejection Fraction: A Prospective Observational Study
نویسندگان
1 Blood Purification Center, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
2 Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
3 Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
4 Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
5 Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
6 Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
doi
10.22034/ircmj.2025.455627.1167چکیده
Background and Objectives: Sacubitril/valsartan (SV) is an angiotensin receptor neprilysin inhibitor (ARNI) that has a positive effect on cardiac remodeling and antihypertensive. However, there are few studies on ARNI in maintenance hemodialysis (MHD) patients with preserved ejection fraction heart failure (HFpEF). To observe the effect of ARNI on the echocardiographic parameters, N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood pressure (BP) in MHD patients with HFpEF. Methods: This was a prospective and observational study that enrolled 37 MHD patients with HFpEF, divided into an ARNI group and a non-ARNI group through a non-randomized controlled method. Patients were followed up for 15 (8-20) months. Analyze the changes in indicators from baseline to follow-up in two groups of patients. Results: Left ventricular end-diastolic diameter (LVEDD), left ventricular mass index (LVMI), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular stroke volume (LVSV) in the ARNI group were lower than those at baseline (P < 0.05). NT-proBNP and BP also showed reductions. Systolic blood pressure (SBP) before hemodialysis (HD), diastolic blood pressure (DBP) before HD, SBP during HD, SBP after HD, and DBP after HD in the ARNI group decreased compared to baseline (P<0.05), and SBP before HD and during HD in the ARNI group were lower than those in the non-ARNI group which were no difference at baseline (P<0.05). LVEDD, left ventricular end-systolic diameter (LVESD), LVMI, left atrial diameter (LAD), left ventricular posterior wall thickness (LVPWD), LVEDV, LVESV, and LVSV in the ARNI group were more severe than those in the non-ARNI group at baseline (P<0.05), but there was no difference in these parameters between the two groups of patients at follow-up. The degree of improvement value in LVMI, LVEDV, LVEDD, and LVSV in the ARNI group was greater than that in the non-ARNI group (P<0.05). The other indicators between the two groups were no different. Conclusion: ARNI improved cardiac remodeling in MHD patients with HFpEF.
