Lack of relationship between the short-term hemodynamic effects of captopril and subsequent clinical responses.
Lack of relationship between the short-term hemodynamic effects of captopril and subsequent clinical responses.
复制标题
卡托普利的短期血流动力学效应与随后的临床反应之间缺乏关系。
DOI：
10.1161/01.cir.69.6.1135
复制
发表时间：
1984
期刊：
影响因子：
37.8
通讯作者：
Topic,N
中科院分区：
文献类型：
--
作者：
Massie,BM;Kramer,BL;Topic,N
尽管存在巨大的潜在社会经济和临床影响，但在心力衰竭血管扩张剂治疗开始时血液动力学监测的作用仍有待确定。因此，我们对14名纽约心脏协会II类或III类慢性充血性心力衰竭的稳定患者在卡托普利治疗前和最初48小时进行了静息和运动血液动力学研究。通过评估临床状态的变化以及3个月后运动耐量、心脏大小和射血分数的测量变化来确定他们对治疗的临床反应。这些指标在整个组中均有显著改善，但基线血流动力学和对卡托普利的血流动力学反应在有明显改善的患者和没有变化的患者之间差异不大。血流动力学测量与临床分级、运动耐量、心脏大小和射血分数的变化之间的相关性通常较差。即使它们达到了显著性，这些相关性也过于松散，无法预测卡托普利对个体受试者的临床疗效。这些发现表明，在卡托普利开始使用期间，常规使用侵入性血流动力学监测是不必要的，并且可能会产生误导，尽管这种测量对诊断、复杂情况患者的管理和调查仍然有价值。除了临床评估外，对卡托普利的反应最好通过运动耐量和心脏大小的连续测量来评估。
The role of hemodynamic monitoring during the initiation of vasodilator therapy for heart failure remains to be defined, despite the tremendous potential socioeconomic and clinical ramifications. We therefore performed resting and exercise hemodynamic studies before and during the initial 48 hr of captopril therapy in 14 stable patients with New York Heart Association Class II or III chronic congestive heart failure. Their clinical response to therapy was determined by evaluating changes in clinical status and the measured changes in exercise tolerance, heart size, and ejection fraction after 3 months. Significant improvement in each of these indexes was found for the group as a whole, but the baseline hemodynamics and the hemodynamic responses to captopril differed little between the patients showing marked improvement and those exhibiting little or no change. Correlations between the hemodynamic measurements and the changes in clinical class, exercise tolerance, heart size, and ejection fraction were generally poor. Even when they achieved significance, these correlations were too loose to allow prediction of the clinical efficacy of captopril in individual subjects. These findings indicate that the routine use of invasive hemodynamic monitoring during the initiation of captopril is unnecessary and potentially misleading, although such measurements remain valuable for diagnosis, the management of patients with complex conditions, and for investigation. The response to captopril may be best evaluated by serial measurements of exercise tolerance and heart size in addition to clinical assessment.