Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction
Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction
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DOI：
10.1016/s0735-1097(01)01233-5
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发表时间：
2001-06-01
影响因子：
24
通讯作者：
Kinoshita, M
中科院分区：
文献类型：
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作者：
Hayashi, M;Tsutamoto, T;Kinoshita, M
目的 该研究评估心钠素 (ANP) 与硝酸甘油 (GTN) 相比对首次前壁急性心肌梗死 (AMI) 后左心室 (LV) 重构的影响。 背景 与 GTN 相比，ANP 抑制肾素-血管紧张素-醛固酮系统和内皮素-1 (ET-1)，从而刺激 LV 方法 60 例首次前壁 AMI 患者在直接经皮腔内冠状动脉成形术后随机分为 ANP (n = 30) 组或 GTN (n = 30) 组。我们评估了急性期和一个月后的左心室射血分数（LVEF）、舒张末期容积指数（LVEDVI）和收缩末期容积指数（LVESVI）。我们还在研究药物输注期间测量了神经体液因素。 结果 两组之间的基线特征或 LVEF（46.9 +/- 1.0 与 46.8 +/- 1.3%）没有差异。尽管输注期间血流动力学无差异，但1个月后两组的LVEF tvas均较基线值显着改善，但ANP组改善幅度大于GTN组（54.6 +/- 1.1%、50.8 +/- 1.3%，p < 0.05）。 ANP 组可预防左心室扩大（LVEDVI，85.8 +/- 3.1 ml/m(2) 至 87.3 +/- 2.7 ml/m(2)；p = ns，LVESVI，45.6 +/- 1.8 ml/m(2) 至 41.0 +/- 2.1 ml/m(2)，p < 0.05），但 GTN 组则不然（左心室舒张指数， 86.2 +/- 4.1 至 100.2 +/- 3.7，p < 0.01； LVESVI，46.3 +/- 2.8 ml/m(2) 至 51.1 +/- 3.0 ml/m(2)，p = ns)。在输注过程中，与 GTN 相比，ANP 可以抑制血浆中醛固酮、血管紧张素 II 和 ET-1 的水平。 结论 这些研究结果表明，在首次发生前壁 AMI 的患者中，ANP 输注可以比 GTN 更好地预防左室重构，并有效抑制醛固酮、血管紧张素 II 和 ET-1。 (J Am Coll Cardiol 2001；37:1820-6) (C) 2001 年，美国心脏病学会。
OBJECTIVES The study evaluates the effect of atrial natriuretic peptide (ANP) compared with nitroglycerin (GTN) on left ventricular (LV) remodeling after first anterior acute myocardial infarction (AMI).BACKGROUND Compared with GTN, ANP suppresses the renin-angiotensin-aldosterone system and endothelin-1 (ET-1), which stimulate LV remodeling.METHODS Sixty patients with a first anterior AMI were randomly divided into the ANP (n = 30) or GTN (n = 30) groups after direct percutaneous transluminal coronary angioplasty. We evaluated LV ejection fraction (LVEF), end-diastolic volume index (LVEDVI) and endsystolic volume index (LVESVI) at the acute phase and after one month. We also measured neurohumoral factors during study drug infusion.RESULTS There nas no difference in the baseline characteristics or LVEF (46.9 +/- 1.0 vs. 46.8 +/- 1.3%) between the two groups. Although there was no difference in hemodynamics during the infusion periods, the LVEF tvas significantly improved after one month compared with the baseline value in both groups, but it was improved more in the ANP group than in the GTN group (54.6 +/- 1.1%, 50.8 +/- 1.3%, p < 0.05). Left ventricular enlargement was prevented in the ANP group (LVEDVI, 85.8 +/- 3.1 ml/m(2) to 87.3 +/- 2.7 ml/m(2); p = ns, LVESVI, 45.6 +/- 1.8 ml/m(2) to 41.0 +/- 2.1 ml/m(2), p < 0.05) but not in the GTN group (LVEDVI, 86.2 +/- 4.1 to 100.2 +/- 3.7, p < 0.01; LVESVI, 46.3 +/- 2.8 ml/m(2) to 51.1 +/- 3.0 ml/m(2), p = ns). During the infusion, ANP suppressed plasma levels of aldosterone, angiotensin II and ET-1 compared with GTN.CONCLUSIONS These findings indicate that in patients with a first anterior AMI, an ANP infusion can prevent LV remodeling better than can GTN, and effectively suppresses aldosterone, angiotensin II and ET-1. (J Am Coll Cardiol 2001;37:1820-6) (C) 2001 by the American College of Cardiology.