维立西呱联合四联疗法对心肌梗死后射血分数降低型心力衰竭患者的临床研究OA

Objective To observe the clinical efficacy and safety of vericiguat tablets combined with quadruple therapy in patients with heart failure with reduced ejection fraction(HFrEF)after myocardial infarction.Methods Patients with HFrEF after myocardial infarction were divided into control group and treatment group by drug treatment method.The control group was given standard new quadruple therapy:sacubitril/valsartan tablets 50 mg each time,twice a day,gradually increased to 150 mg·d-1;sustained-release metoprolol tablets 23.75 mg·d-1 initially,increased every 2 weeks to 190 mg·d-1;spironolactone tablets 10-40 mg·d-1;dapagliflozin tablets 10 mg each time,once a day.On the basis of the quadruple therapy in the control group,the treatment group was additionally given vericiguat tablets at an initial dose of 2.5 mg·d-1,which was titrated to the maximum dose of 10 mg·d-1 every 2 weeks.Both groups received continuous treatment for 6 months.The main observation indicators included cardiac function indicators,myocardial fibrosis indicators[transforming growth factor-β1(TGF-β1),connective tissue growth factor(CTGF),soluble suppression of tumorigenicity 2(sST2)],myocardial injury indicators[chromogranin A(CgA),N-terminal pro-B-type natriuretic peptide(NT-proBNP),hypoxia-inducible factor-1α(HIF-1α)],Minnesota living with heart failure questionnaire(MLHFQ)score,total clinical effective rate,adverse drug reactions,and major adverse cardiovascular events(MACE)were compared between the two groups,and the safety was conducted.Results A total of 125 patients were enrolled in the study.63 patients were included in control group and 62 patients in treatment group.After 6 months of treatment,the total clinical effective rate was 77.78％(49 cases/63 cases)in control group and 91.94％(57 cases/62 cases)in treatment group;the left ventricular ejection fraction(LVEF)was(41.37±4.67)％ and(45.18±4.85)％,respectively;the cardiac output(CO)was(4.31±0.60)and(4.69±0.52)L·min-1,respectively;the left ventricular end-systolic volume(LVESV)was(51.28±5.57)and(44.86±4.90)mL,respectively;the left ventricular end-diastolic diameter(LVEDD)was(56.42±6.35)and(52.87±5.84)mm,respectively;the TGF-β1 levels were(49.15±5.27)and(43.48±5.64)ng·L-1,respectively;the CTGF levels were(70.68±7.68)and(61.54±6.59)μg·L-1,respectively;the sST2 levels were(24.83±3.78)and(21.69±2.57)μg·L-1,respectively;the CgA levels were(240.48±25.43)and(182.33±21.58)mg·L-1,respectively;the NT-proBNP levels were(874.31±95.64)and(780.26±82.17)pg·mL-1,respectively;the HIF-1α levels were(12.16±1.58)and(9.25±1.17)ng·L-1,respectively;the MLHFQ physical domain scores were(8.16±0.85)and(7.34±0.92)points,respectively;the emotional domain scores were(5.71±0.73)and(4.15±0.60)points,respectively;the other domain scores were(10.44±1.78)and(8.16±1.39)points,respectively.All intergroup differences of the above indicators were statistically significant(P＜0.05,P＜0.01).The total incidence of MACE was 15.87％(10 cases/63 cases)in control group and 4.84％(3 cases/62 cases)in treatment group,and the difference between the two groups was statistically significant(P＜0.05).There was no significant difference in the total incidence of adverse drug reactions between control group(7.94％)and the treatment group(16.13％)(P＞0.05).Conclusion The combination of vericiguat tablets and quadruple therapy can effectively improve cardiac function,reduce myocardial fibrosis,attenuate myocardial injury,and improve the quality of life in patients with HFrEF after myocardial infarction.