Contractile state is the major determinant of functional outcome in patients with left ventricular dysfunction treated with enalapril.
Contractile state is the major determinant of functional outcome in patients with left ventricular dysfunction treated with enalapril.
复制标题
收缩状态是接受依那普利治疗的左心室功能障碍患者功能结果的主要决定因素。
DOI：
10.1093/oxfordjournals.eurheartj.a061000
复制
发表时间：
1995
影响因子：
39.3
通讯作者：
Pouleur,H
中科院分区：
文献类型：
--
作者：
Mirsky,I;Aoyagi,T;Ihara,T;vanEyll,C;Rousseau,MF;Pouleur,H
大规模的药物试验主要集中在死亡率和发病率上，而较少关注心肌的功能状态。建立了一个模型来评估左心室功能障碍患者的心肌收缩状态，并解决有和无明显心力衰竭患者的功能差异、依那普利的影响以及功能结局的最佳预测因素等问题。压力血管造影数据来自16例明显心力衰竭患者和47例无心力衰竭患者。41例患者在接受依那普利或安慰剂治疗1年后进行了重复研究。将左心室剪影分为18段，估计局部射血分数、壁应力和心肌损伤（%心肌损伤）。通过射血率-负荷前-负荷后关系和基于10个心肌和心室功能参数的评分方法来评估和排名收缩状态。明显心力衰竭患者舒张末期和收缩末期容积（EDV、ESV）显著增高（P< 0.001），射血分数（EF）显著降低（P< 0.009），心肌损伤率显著增高（P< 0.008），收缩状态显著降低。EDV和ESV变化（Δplacebo vs Δenalapril）显著（ΔEDV， P< 0.003； ΔESV， P< 0.014）。依那普利或安慰剂的舒张压-容积关系的方向变化主要取决于基础收缩状态和舒张容积范围。治疗后EF的最佳单一预测指标是评分指数（收缩状态的替代参数）和ESV。依那普利的其他益处包括预防收缩状态不太压抑的患者进一步扩张和延迟心力衰竭的发作。无症状的左室功能障碍患者也应考虑血管紧张素转换酶（ACE）抑制剂治疗。
Large-scale drug trials have focused primarily on mortality and morbidity and less on the functional state of the myocardium. A model was developed to assess myocardial contractile state in patients with left ventricular (LV) dysfunction and to address the questions of differences in function between patients with and without overt heart failure, effects of enalapril, and best predictors of functional outcome.Pressure-angiographic data were obtained from 16 patients with overt heart failure and 47 without heart failure. Repeat studies were conducted in 41 patients following 1 year's treatment with enalapril or placebo. Left ventricular silhouettes were divided into 18 segments to estimate regional ejection fraction, wall stress and myocardial damage (% myocardial damage). Contractile state was assessed and ranked by ejection rate-preload-afterload relationships and by a score method based on 10 myocardial and ventricular function parameters. End-diastolic and end-systolic volumes (EDV, ESV) were significantly greater (P<0·001), ejection fraction (EF) lower (P<0·009), % myocardial damage greater (P<0·008) and contractile state more depressed in patients with overt heart failure.Changes in EDV and ESV (Δplacebo vs Δenalapril) were significant (ΔEDV, P<0·003; ΔESV, P<0·014). Directional shifts in the diastolic pressure-volume relationships with enalapril or placebo depended primarily on the basal contractile state and diastolic volume range. The best single predictors of post-treatment EF were the score index (a surrogate parameter for the contractile state) and ESV. Added benefits of enalapril include the prevention of further dilatation in patients with less depressed contractile state and delay in the onset of heart failure. Asymptomatic patients with LV dysfunction should also be considered for angiotensin converting enzyme (ACE) inhibitor therapy.