The efficacy and safety of left bundle branch pacing combined with sacubitril/valsartan or enalapril in the treatment of elderly coronary heart disease with chronic heart failure

Objective: Left bundle branch pacing (LBBP) is the best alternative to biventricular pacing (BiVP) and cardiac resynchronization therapy (CRT). This study compares the efficacy and safety of LBBP combined with sacubitril/valsartan and LBBP combined with enalapril in treating elderly coronary heart disease (CHD) patients with chronic heart failure (CHF). Methodology: This retrospective observational study included clinical records of elderly CHD patients with CHF who received LBBP treatment at The Affiliated Hospital of Northwest University from January 2022 to August 2024. Based on the postoperative treatment regimen, patients were divided into the LBBP & sacubitril/valsartan and the LBBP & enalapril groups. Levels of left ventricular end diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), QRS duration, N-terminal B-type natriuretic peptide precursor (NT proBNP), soluble growth stimulating gene 2 protein (sSt2), matrix metalloproteinase-9 (MMP-9) and the occurrence of adverse events were compared between two groups before and after treatment. Results: A total of 111 patients met the inclusion criteria. Of them, 53 patients comprised the LBBP & sacubitril/valsartan group and 58 patients comprised the LBBP & enalapril group. After treatment, levels of LVEDd, LVEF, NT proBNP, sSt2 and MMP-9 in the LBBP & sacubitril/valsartan group were significantly improved compared to those in the LBBP & enalapril group (all P<0.05). There was no statistically significant difference in the occurrence of adverse events between the two groups (both P>0.05). Conclusions: LBBP combined with sacubitril/valsartan is more effective in treating elderly CHD with CHF than LBBP combined with enalapril.