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April 21, 2021MedicineOpen Access

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

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Why the study?

The study aimed to investigate the effects of standard heart failure treatment versus sequential treatment with rhBNP alone or rhBNP followed by sacubitril/valsartan on cardiac structure, pulmonary artery pressure, inflammation, and oxidative stress in acute heart failure.

Does sequential treatment with recombinant human BNP and sacubitril/valsartan improve cardiac structure, pulmonary artery pressure, and biomarkers in patients with acute heart failure?

Comparison

Sequential rhBNP followed by sacubitril/valsartan vs rhBNP alone vs standard treatment

Design

Randomized controlled trial

Follow-up

36 weeks

Key result

Sequential treatment with recombinant human brain natriuretic peptide followed by sacubitril/valsartan significantly improved cardiac structure, pulmonary artery pressure, and biomarkers of myocardial injury compared to standard treatment in patients with acute heart failure.

Authors

ZPZhihua PangCPChang PanZYZhuhua Yao

Discussion

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Overview

Supports sequential rhBNP then sacubitril/valsartan to augment LVEF recovery in acute HF; extends randomized sequencing data beyond monotherapy.

Study Design

Type

RCT (n=300)

Randomization

Random number table method

Multicenter

No

Structured PICO

Does sequential treatment with recombinant human BNP and sacubitril/valsartan improve cardiac structure, pulmonary artery pressure, and biomarkers in patients with acute heart failure?

P
Population
300 patients aged 53 to 81 years with acute heart failure and ejection fraction <40% were randomized to standard treatment, rhBNP, or sequential rhBNP and sacubitril/valsartan and followed for 36 weeks.
I
Intervention
Sequential treatment: basic treatment for heart failure (excluding ACEI/ARB) combined with recombinant human BNP (rhBNP) via intravenous injection of 1.5 mg/kg at a rate of 0.0075 mg/kg/min for 3 consecutive days, followed by sacubitril/valsartan gradually increased from 50 mg twice daily to 200 mg twice daily for 36 weeks.
C
Comparator
Two comparator arms: 1) Standard treatment group receiving basic heart failure treatment (ACEI, beta-blocker, mineralocorticoid antagonist); 2) rhBNP group receiving basic treatment combined with rhBNP.
O
Outcome
First rehospitalization for heart failure and death from cardiovascular diseasecomposite

Main Result

Absolute Event Rate: 14.4% vs 5.29%

p-value: p=<0.05

Sequential treatment with recombinant human BNP followed by sacubitril/valsartan significantly improves cardiac structure, pulmonary artery pressure, and biomarkers of heart failure compared to standard therapy or rhBNP alone.

Limitations

  • Small sample size
  • Single-center study design
  • Novel signaling pathways need to be discovered and verified in future studies

Cite This Study

Pang et al. (2021) conducted an RCT in Acute heart failure (n=300). Sequential treatment with recombinant human brain natriuretic peptide (rhBNP) followed by sacubitril/valsartan vs. Standard treatment (ACEI, beta blocker, mineralocorticoid antagonist) or rhBNP alone was evaluated on Decrease in pulmonary artery pressure at 36 weeks (p=<0.05). Sequential treatment with recombinant human brain natriuretic peptide followed by sacubitril/valsartan significantly improved cardiac structure, pulmonary artery pressure, and biomarkers of myocardial injury compared to standard treatment in patients with acute heart failure.

synapsesocial.com/papers/6a9a20c75804b0b5899e3ceehttps://doi.org/10.1097/md.0000000000025621
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