A study of the sequential treatment of acute heart failure with sacubitril/valsartan by recombinant human brain natriuretic peptide

Abstract

This study aimed to investigate the effects of the basic treatment for heart failure and sequential treatment with rh-brain natriuretic peptide (rhBNP) alone or the combination of rhBNP and sacubitril/valsartan. Cardiac structure, pulmonary artery pressure, inflammation and oxidative stress in patients with acute heart failure were evaluated. Three hundred patients with acute heart failure were included. According to the random number table method, the patients were divided into 3 groups of 100 patients per group: the standard treatment group (treated with an angiotensin-converting enzyme inhibitor, β receptor blocker, and corticosteroid antagonist), rhBNP group (basic treatment combined with rhBNP) and sequential treatment group (basic treatment for heart failure combined with rhBNP followed by sacubitril/valsartan). The changes in NT-probrain natriuretic peptide (BNP) levels, cardiac troponin T (cTnT) levels, cardiac structure, pulmonary artery pressure, and the levels inflammatory factors and oxidative stress factors were compared among the 3 groups at 1, 4, 12, and 36 weeks after treatment. The sequential treatment group displayed superior outcomes than the standard treatment group and the rhBNP group in terms of left atrium diameter, left ventricular end diastolic volume, left ventricular ejection fraction, pulmonary artery pressure, NT-proBNP levels, and cTnT levels, which respond to damage to the heart structure and myocardium. This result may be related to the decreased levels of inflammatory factors and the correction of oxidative stress imbalance. Sacubitril/valsartan significantly reduce the serum levels of inflammatory factors in patients with acute heart failure while decreasing the levels of oxidizing factors and increasing the levels of antioxidant factors. These changes may be one of the explanations for the better cardiac structure and better pulmonary artery pressure observed in the sequential treatment group.

Heart Failure (HF): Recent innovations in clinical therapy and critical profiles of acute and chronic forms

“…Pang Z, et al [9] A study of the sequential treatment of acute heart failure with sacubitril/valsartan by recombinant human brain natriuretic peptide R: 300…”

“…one explanation for the improved cardiac structure and pulmonary artery pressure observed in the sequential treatment group[9]. f) Treatment with sodium-glucose co-transporter-2 inhibitors induces an initial 3-5 ml/min/1.73 m2 decline in the estimated glomerular fi ltration rate (eGFR).Although considered to be of hemodynamic origin and largely reversible, this 'eGFR dip' may cause concern in clinical practice, which highlights the need to better understand its incidence and clinical implications.…”

The Rare Condition of Left Ventricular Non-Compaction and Reverse Remodeling

“…In HF models, sacubitril/valsartan reduced the production of oxidative products, intracellular reactive oxygen species (ROS) such as inflammatory factors (IL-1β, interleukins IL-6, and TNF-α), and malondialdehyde [ 79 ]. In HF patients, a reduced oxidative stress and inflammation was revealed during therapy with sacubitril/valsartan [ 80 , 81 ].…”

Molecular mechanisms of sacubitril/valsartan in cardiac remodeling

“…Oxidative stress and inflammation are the culprits in almost all diseases including heart failure. Sacubitril/valsartan mitigates oxidative stress and inflammation in vivo ( Yang et al, 2019 ; Raj et al, 2021 ) and in vitro ( Peng et al, 2020 ) models of heart failure as well as in patients with the disease ( Acanfora et al, 2020 ; Bunsawat et al, 2021 ; Pang et al, 2021 ). The drug diminished production of intracellular reactive oxygen species (ROS), oxidative products such as malondialdehyde, and inflammatory factors (tumor necrosis factor-α, TNF-α; interleukins IL-6 and IL-1β) in the models.…”