关键词: 射血分数保留心力衰竭, 糖尿病, 达格列净, 沙库巴曲缬沙坦钠, 主要心血管不良事件

Abstract:

Objective： To investigate the cardioprotective effect of dapagliflozin combined with sacubitril valsartan sodium in patients with heart failure with preserved ejection fraction （HFpEF） combined with diabetes mellitus， and to analyze its effect on major adverse cardiovascular events （MACE）.Methods： 200 cases of HFpEF patients with diabetes mellitus in our hospital from June 2021 to June 2023 were divided into group A （n=50）， group B （n=50）， group C （n=50） and group D （n=50） according to random number table method. Group A was treated with conventional therapy + dapagliflozin + sacubitril valsartan sodium， group B was treated with conventional therapy + depagliflozin， group C was treated with conventional therapy + sacubitril valsartan sodium， and group D was treated with conventional therapy. The course of treatment was 6 months. The overall efficacy， left ventricular mass index （LVMI）， left ventricular ejection fraction （LVEF）， left ventricular end-diastolic diameter （LVEDD） and left ventricular end-systolic diameter （LVESD） of the 4 groups were compared before treatment， after 3 months of treatment and after 6 months of treatment. Plasma N-terminal B-type natriuretic peptide （NT-proBNP） levels were detected. The 6MWD and Kansas City Cardiomyopathy Questionnaire （KCCQ） scores were compared. The adverse reactions during the treatment was observed. Patients were followed up from the day of discharge to 12 months after discharge， and the incidence of MACE was recorded. Results： The total effective rate of group A was 96.00%， which was higher than that of group B， C and D （78.00%， 78.00% and 60.00%） （P < 0.05）. LVMI， LVEDD and LVESD of 3 and 6 months after treatment in the 4 groups were lower than those before treatment. LVMI， LVEDD and LVESD of 3 and 6 months after treatment in groups A， B and C were lower than those in group D， and group A was lower than those in groups B and C （P < 0.05）. NT-proBNP level in the 4 groups at 3 and 6 months after treatment was lower than that before treatment， and group A， B and C were lower than group D， and group A was lower than group B and C （P < 0.05）. After 3 and 6 months of treatment， 6MWD and KCCQ scores in the 4 groups were higher than those before treatment， and groups A， B and C were higher than group D， and group A was higher than group B and C （P < 0.05）. There was no seatistic difference in the incidence of adverse reactions among the 4 groups （P > 0.05）. The incidence of MACE in group A （2.00%） was lower than that in group D （20.00%） （P < 0.05）. Conclusion： Dapagliflozin combined with sacubitril valsartan sodium can improve the therapeutic effect of patients with HFpEF combined with diabetes mellitus， strengthen the protective effect on heart， improve exercise tolerance and reduce the incidence of MACE.

Key words: Ejection fraction preserving heart failure； , Diabetes mellitus； , Dapagliflozin； , Sacubitril valsartan sodium； , Major adverse cardiovascular events