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

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.

Figure 1

Changes in cardiac structure and the ejection fraction before and after treatment. Compared with the standard treatment group, the rhBNP group exhibited a significant difference (P < .05). The sequential treatment group exhibited significant differences compared with the standard treatment group (P < .05). The sequential treatment group presented significant differences compared with the rhBNP group (P < .05). LAD = left atrial diameters, LVEDV = left ventricular end-diastolic volume, LVEF = left ventricular ejection fraction, rhBNP = recombinant human brain natriuretic peptide.

Figure 2

Decreased pulmonary arterial pressure and changes in the NT-proBNP and cTnT concentrations before and after treatment. Compared with the standard treatment group, the rhBNP group presented a significant difference in these parameters (P < .05). The sequential treatment group exhibited significant differences compared with the standard treatment group (P < .05). The sequential treatment group presented significant differences compared with the rhBNP group (P < .05). cTnT = cardiac troponin T, NT-proBNP = N-terminal B-type natriuretic peptide, rhBNP = recombinant human brain natriuretic peptide.

Figure 3

Changes in the concentrations of inflammatory factors and oxidative stress-related factors. Compared with the standard treatment group, the rhBNP group exhibited significant differences in these parameters (P < .05). The sequential treatment group displayed significant differences compared with the standard treatment group (P < .05). The sequential treatment group presented significant differences compared with the rhBNP group (P < .05). GSH-PX = glutathione-peroxidase, IL-6 = interleukin-6, MDA = serum malondialdehyde, rhBNP = recombinant human brain natriuretic peptide, TNF-α = tumor necrosis factor α, XO = xanthine oxidase.