Objectives: The present study aimed to observe the beneficial effects of sacubitril-valsartan at a lower dose of 24/26mg BID in a third-world country (Pakistan). Methodology: This was a randomized, prospective, observational cohort study conducted at a tertiary care hospital in patients diagnosed, managed, and discharged as a case of heart failure with reduced ejection fraction and followed up in the cardiac outpatient department 6 weeks post-discharge. The required information was collected from the patients by means of a designed questionnaire containing minimal personal information, including age and gender. The questionnaire used was an FDA-approved KCCQ indicated for the use of assessing the quality-of-life change before and following the therapy indicated for HF with reduced ejection fraction. The data was analyzed using SPSS version 26. Results: This study included a total of 77 patients out of which 49 were male (63.6%) and 28 were female (36.4%). The mean age of the patients included was 60.05± 11.80 years. 68.8% of them were hypertensive and 51.9% were diabetic. All patients included were those with reduced Ejection Fraction out of which 29.9% had EF between 20-25%, 49.3 % had it between 30-35% whereas 20.8% of patients had an EF of 40%. In the case of NYHA class before starting Sacubitril/Valsartan approximately 84.4% of patients were in class 3 and 15.6% of them belonged to class 4. The functional class was improved 6 weeks post-treatment in which 79.2% of patients had functional class 2 and 20.8% of them had class 3. The comparison between KCCQ scores of heart failure patients before treatment and after treatment with sacubitril/valsartan at the dosage of 24/26mg BID were statistically significant. Conclusion: It was thus concluded from the study that even a low dose of sacubitril-valsartan results in improved quality of life as assessed by KCCQ scoring in patients with heart failure with reduced ejection fraction.
Objectives: To compare the levels of N Terminal- ProBrain natriuretic peptide (NT-proBNP) and Troponin I (Trop I) to predict left ventricular ejection fraction (LVEF) in patients presenting with first ST-elevation myocardial infarction (STEMI). Methodology: A cross-sectional study was carried out in Cardiology department of a tertiary care hospital from June to November 2021. A total of 150 patients who presented at emergency department with first STEMI and underwent primary percutaneous coronary intervention (PCI) were included. The patient’s second set of troponin I and NT-proBNP were collected during hospitalization. Echocardiography was done. Left ventricular function was assessed using modified Simpson’s method. For data analysis, SPSS 21 was used. Results: The mean age was 60.60±11.1 years. There were 76% males, 53% hypertensive, 44% diabetic, 14% smokers with the most prominent type of myocardial infarction being anterior wall myocardial infarction accounting for 76.7%. Mean Trop I was 12.2±6.81 ng/ml, 9.5±8.63 ng/ml and 3.0±5.41 ng/ml for LVEF≤40%, 41-49% and >50% respectively while NT-proBNP was 7136.4±7.97pmol/l, 2328.9±3498.6pmol/l and 441±283.6pmol/l for LVEF ≤40%, 41-49%, and >50% respectively. We found a significant mean difference for Trop I (p=0.000) and NT-proBNP (p=0.0001). There was an inverse significant relationship of left ventricular ejection fraction with Trop I (r=-0.290, p=0.000) and NT- proBNP (r=-0.388, p=0.000). Conclusion: In comparison to Troponin I, NT-proBNP serves as a better marker to predict LVEF in patients presenting with first STEMI.
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