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.
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?
RCT (n=300)
Random number table method
No
Does sequential treatment with recombinant human BNP and sacubitril/valsartan improve cardiac structure, pulmonary artery pressure, and biomarkers in patients with acute heart failure?
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.
Supports sequential rhBNP then sacubitril/valsartan to augment LVEF recovery in acute HF; extends randomized sequencing data beyond monotherapy.
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.
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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.
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