Effect of dapagliflozin combined with sacubitril/valsartan sodium on ventricular remodeling in patients with heart failure with reduced ejection fraction

Wang Fei; Lu Yaojun

doi:10.3760/j.issn.1673-4777.2026.02.003

Abstract：Objective To investigate the effect of dapagliflozin combined with sacubitril/valsartan sodium on ventricular remodeling in patients with heart failure with reduced ejection fraction(HFrEF).Methods A total of 120 HFrEF patients admitted to Baotou Central Hospital of Inner Mongolia Autonomous Region from April 2023 to March 2024 were selected and divided into observation group(60 cases)and control group(60 cases)according to the random number table method.A double-blind,placebo-controlled design was adopted.Both groups received standard drug treatment.On this basis,the control group was treated with sacubitril/valsartan sodium+placebo,and the observation group was treated with sacubitril/valsartan sodium+dapagliflozin,with continuous treatment for 12 months.The clinical efficacy,ventricular remodeling and cardiac function[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),interventricular septal end-diastolic thickness(IVST),early/late diastolic maximum flow velocity of mitral valve(E/A)],exercise capacity and quality of life[6 min walk test distance,minnesota living with heart failure questionnaire(MLHFQ)score],myocardial injury and myocardial fibrosis indexes[N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),laminin(LN),procollagen Ⅲ peptide(PⅢP)],as well as serum levels of soluble suppression of tumorigenicity 2(sST2),pentraxin 3(PTX-3)and inflammatory indexes[C-reactive protein(CRP),interleukin-6(IL-6),IL-1β,tumor necrosis factor-α(TNF-α)],and the incidence of clinical adverse events during treatment were compared between the two groups.Results The clinical effective rate of the observation group was higher than that of the control group[95.0％(57/60)vs 83.3％(50/60)](P=0.040).Compared with before treatment,after treatment,LVEDD,LVESD and IVST decreased,serum levels of NT-proBNP,cTnI,LN,PⅢP,CRP,IL-6,IL-1βand TNF-αreduced in both groups,with the observation group lower than the control group;LVEF and E/A increased,with the observation group higher than the control group(all P<0.05).Compared with before treatment,after treatment,6 min walk test distance increased and MLHFQ score decreased in both groups,with the observation group having longer walk distance and lower score than the control group(all P<0.05).Compared with before treatment,after treatment,serum sST2 and PTX-3 levels decreased in both groups[observation group:(19±4)μg/L vs(48±10)μg/L,(3.1±0.6)ng/L vs(5.8±0.9)ng/L;control group:(24±3)μg/L vs(48±8)μg/L,(3.6±0.7)ng/L vs(5.9±0.8)ng/L],with the observation group lower than the control group(all P<0.05).During treatment,there was no significant difference in the total incidence of cardiovascular adverse events between the two groups(P=0.752).Conclusion Dapagliflozin combined with sacubitril/valsartan sodium in the treatment of patients with HFrEF can effectively inhibit ventricular remodeling,reduce myocardial injury and inflammatory response,significantly improve cardiac function,and enhance exercise tolerance and quality of life.