Experience in the use of angiotensin receptor neprilysin inhibition in patients with chronic heart failure and chronic obstructive pulmonary disease

Abstract

The results of evaluating the effectiveness of the use of an angiotensin receptor-neprilysin inhibitor (valsartan / sacubitrile) in addition to standard therapy in comorbid patients suffering from chronic heart failure and chronic obstructive pulmonary disease are presented. It was revealed that the combination of valsartan / sacubitrile has a more pronounced therapeutic effect than the separate use of valsartan. At the same time, the level of the N-terminal cerebral natriuretic peptide decreases, especially in patients with a left ventricular ejection fraction of less than 40%, which indicates the effect on the pathogenetic mechanisms associated with the formation and progression of chronic heart failure. The effectiveness of the recommended combination of valsartan / sakubitrile is confirmed by a significant increase in the ejection fraction of the left ventricle of patients suffering from chronic heart failure, which significantly affects the increase in exercise tolerance and improving the quality of life. Improving the quality of life is confirmed by the positive dynamics of the «symptoms», «activity» blocks of the questionnaire for patients suffering from respiratory diseases, St. George’s hospital and «mobility», «usual daily activities» of the quality of life questionnaire, which also shows the advantage of using valsartan / sakubitril and increases patient commitment to prescribed therapy. A decrease in the cavity of the left atrium and a decrease in pressure in the pulmonary artery indicates not only an improvement in the function of the left chambers of the heart, but also of the right ventricle.

Keywords

chronic heart failure / chronic obstructive pulmonary disease / comorbidity / natriuretic peptides / neprilysin / valsartan / sacubitril / questionnaire of St. George’s Hospital / questionnaire for quality of life

References

[1] Кароли, Н.А. Коморбидность при хронической обструктивной болезни легких / Н.А. Кароли [и др.] // Тер. архив. - 2008. - № 3. - С. 20-24.

[2] Лазебник, Л.Б. Полиморбидность в гериатрической практике: количественная и качественная оценка / Л.Б. Лазебник, Ю.В. Конев, Л.И. Ефремов // Клин. геронтология. - 2012. - № 1 (2). - С. 36-42.

[3] Мареев, В.Ю. Клинические рекомендации. Хроническая сердечная недостаточность (ХСН) / В.Ю. Мареев [и др.] // Сердечная недостаточность. - 2017. - № 18 (1). - С. 3-40.

[4] Парфёнов, С.А. Современные направления профилактики внебольничной пневмонии у военнослужащих, проходящих военную службу по призыву / С.А. Парфенов [и др.] // Антибиотики и химиотерапия. - 2018. - № 63. - С. 1-7.

[5] De Miguel, J. The association between COPD and heart failure risk: a review / J. De Miguel, J. Chancafe, R. Jiménez // Int. J. Chron. Obstruct. Pulm. Dis. - 2013. - Vol. 8. - P. 305-312.

RIGHTS & PERMISSIONS

Kalimulin O.A., Koltsov A.V., Tyrenko V.V., Bologov S.G., Odin V.I., Tsygan E.N.