Efficacy of Sacubitril/Valsartan Combined With Metoprolol on Cardiac Function, Cardiac Remodeling, and Endothelial Function in Patients With Coronary Heart Disease and Heart Failure.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
British journal of hospital medicine Pub Date : 2025-04-25 Epub Date: 2025-04-21 DOI:10.12968/hmed.2025.0120
Tongyu Zhu, Yingjing Song
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引用次数: 0

Abstract

Aims/Background Coronary heart disease (CHD) combined with heart failure results in a rapidly progressing disease with an acute onset, posing a significant threat to a patient's survival. Metoprolol, a β-blocker, is effective in treating heart failure; however, due to its complex pathogenesis, the efficacy of monotherapy in managing disease progression remains suboptimal. Sacubitril/valsartan, an angiotensin II receptor antagonist, is another widely used drug for treating heart failure. The combination of the two drugs may play a synergistic role in effectively managing heart failure through different mechanisms. This study aims to investigate the effects of sacubitril/valsartan combined with metoprolol on cardiac function, cardiac remodeling, and endothelial function in patients with CHD and heart failure. Methods This retrospective analysis included 138 CHD patients combined with heart failure who received care at Linhai Hospital of Traditional Chinese Medicine between January 2022 and January 2024. Based on the treatment regimen, patients were divided into two groups. Patients receiving metoprolol monotherapy were included in the Metoprolol group (n = 61), while those receiving a combination of sacubitril/valsartan and metoprolol were assigned to the Combination group (n = 77). The cardiac function [New York Heart Association (NYHA) cardiac function classification], myocardial injury markers [serum cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP)], cardiac remodeling function [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD)], endothelial function [serum endothelin-1 (ET-1), nitric oxide (NO)] were compared between these two groups before treatment and 3 months post-treatment. Additionally, the two groups were comparatively assessed for the incidence of adverse reactions during the treatment period. Results Following treatment, the NYHA cardiac function grading was significantly improved in the Combination group than in the Metoprolol group (p = 0.014). After treatment, the Combination group demonstrated significantly lower serum cTnI and NT-proBNP levels than the Metoprolol group (p < 0.05). After treatment, the Combination group had substantially higher LVEF and lower LVEDD and LVESD than the Metoprolol group (p < 0.05). Furthermore, the Combination group showed a significant decrease in serum ET-1 levels and an increase in serum NO levels compared to the Metoprolol group (p < 0.05). During the treatment period, there was no significant difference in the incidence of adverse reactions between the two groups (p > 0.05). Conclusion Sacubitril/valsartan combined with metoprolol is a safe, effective, and viable treatment option for patients with CHD combined with heart failure. This combination therapy may further improve cardiac and endothelial function by reducing cardiac remodeling, without increasing the risk of adverse reactions. This study offers a new drug combination regimen (sacubitril/valsartan combined with metoprolol) for patients with CHD combined with heart failure. This regimen further improves the cardiac and endothelial function, inhibits cardiac remodeling, and has good safety.

沙比利/缬沙坦联合美托洛尔对冠心病心衰患者心功能、心脏重构和内皮功能的影响
目的/背景冠心病(冠心病)合并心力衰竭是一种急性发作的快速进展疾病,对患者的生存构成重大威胁。美托洛尔是一种β受体阻滞剂,可有效治疗心力衰竭;然而,由于其复杂的发病机制,单药治疗在控制疾病进展方面的疗效仍然不理想。舒比利/缬沙坦是一种血管紧张素II受体拮抗剂,是另一种广泛用于治疗心力衰竭的药物。两种药物联合使用可能通过不同的机制在有效治疗心力衰竭方面发挥协同作用。本研究旨在探讨苏比里尔/缬沙坦联合美托洛尔对冠心病合并心力衰竭患者心功能、心脏重构和内皮功能的影响。方法回顾性分析2022年1月至2024年1月在临海中医院就诊的138例冠心病合并心力衰竭患者。根据治疗方案将患者分为两组。接受美托洛尔单药治疗的患者被分为美托洛尔组(n = 61),而接受苏比里尔/缬沙坦与美托洛尔联合治疗的患者被分为联合组(n = 77)。心功能[纽约心脏协会(NYHA)心功能分类]、心肌损伤标志物[血清心肌肌钙蛋白I (cTnI)、n端前脑利钠肽(NT-proBNP)]、心脏重构功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)]、内皮功能[血清内皮素-1 (ET-1)]、两组治疗前及治疗后3个月一氧化氮(NO)含量比较。并比较两组患者治疗期间不良反应的发生情况。结果治疗后,联合用药组NYHA心功能评分明显高于美托洛尔组(p = 0.014)。治疗后,联合用药组血清cTnI、NT-proBNP水平明显低于美托洛尔组(p < 0.05)。治疗后,联合用药组LVEF显著高于美托洛尔组,LVEDD和LVESD显著低于美托洛尔组(p < 0.05)。与美托洛尔组相比,联合用药组血清ET-1水平显著降低,血清NO水平显著升高(p < 0.05)。治疗期间,两组不良反应发生率比较,差异无统计学意义(p < 0.05)。结论Sacubitril/缬沙坦联合美托洛尔治疗冠心病合并心力衰竭是一种安全、有效、可行的治疗方案。这种联合治疗可以通过减少心脏重塑进一步改善心脏和内皮功能,而不会增加不良反应的风险。本研究为冠心病合并心力衰竭患者提供了一种新的联合用药方案(sacubitril/缬沙坦联合美托洛尔)。该方案进一步改善心脏和内皮功能,抑制心脏重塑,安全性好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
British journal of hospital medicine
British journal of hospital medicine 医学-医学:内科
CiteScore
1.50
自引率
0.00%
发文量
176
审稿时长
4-8 weeks
期刊介绍: British Journal of Hospital Medicine was established in 1966, and is still true to its origins: a monthly, peer-reviewed, multidisciplinary review journal for hospital doctors and doctors in training. The journal publishes an authoritative mix of clinical reviews, education and training updates, quality improvement projects and case reports, and book reviews from recognized leaders in the profession. The Core Training for Doctors section provides clinical information in an easily accessible format for doctors in training. British Journal of Hospital Medicine is an invaluable resource for hospital doctors at all stages of their career. The journal is indexed on Medline, CINAHL, the Sociedad Iberoamericana de Información Científica and Scopus.
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