EFFECTS OF LONG-TERM ENALAPRIL THERAPY ON CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION - RESULTS OF THE SOLVD ECHOCARDIOGRAPHY SUBSTUDY
EFFECTS OF LONG-TERM ENALAPRIL THERAPY ON CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION - RESULTS OF THE SOLVD ECHOCARDIOGRAPHY SUBSTUDY
复制标题
DOI：
10.1161/01.cir.91.10.2573
复制
发表时间：
1995-05-15
期刊：
影响因子：
37.8
通讯作者：
SHELTON, B
中科院分区：
文献类型：
--
作者：
GREENBERG, B;QUINONES, MA;SHELTON, B
背景左心室功能不全（SOLVD）的研究表明，依那普利治疗可显著改善左心室功能不全患者的临床病程。这个子研究的目标是评估左心室结构和功能的变化，在SOLVD患者和测试的假设，依那普利抑制重塑患者与LV dysfunction.Methods和Results患者进入两个预防和治疗组的SOLVD从5的23个临床中心被招募为这个子研究。301名参与研究的患者在随机分组接受依那普利或安慰剂治疗前，以及治疗4个月和12个月后，根据标准方案进行多普勒超声心动图评估。在中心核心实验室以设盲方式分析记录的数据。基线临床特征分析显示，入组子研究的患者通常代表SOLVD人群，但预防组患者在子研究组中的代表性略高（69.8%，而其余SOLVD患者为61.9%）。依那普利组显示二尖瓣环E波与A波速度比显著降低（主要是由于E波速度降低），这种反应与安慰剂组不同（P= 0.030）。依那普利组E/A比值的变化与血浆心钠素的变化显著相关（r= 0.56; P <0.01）。安慰剂组左室舒张末期和收缩末期容积增加，而依那普利组无此现象，两组间反应差异显著（分别为P= 0.025和0.019）。安慰剂组患者的左心室质量趋于增加，而依那普利治疗组患者的左心室质量趋于减少，两组之间的反应差异非常显着（P小于或等于0.001）。结论这些数据表明依那普利可减弱左心室扩张和肥大的进行性增加。左心室功能障碍患者。结果支持SOLVD试验中报告的依那普利的有利作用与抑制LV重构相关的可能性。
Background Studies of Left Ventricular Dysfunction (SOLVD) demonstrated that enalapril therapy significantly improved the clinical course of patients with left ventricular (LV) dysfunction. The goals of this substudy were to evaluate changes in LV structure and function in SOLVD patients and to test the hypothesis that enalapril inhibits remodeling in patients with LV dysfunction.Methods and Results Patients entering both the prevention and treatment arms of SOLVD from 5 of the 23 clinical centers were recruited for this substudy. The 301 patients who participated underwent Doppler-echocardiographic evaluation according to standard protocol before randomization to either enalapril or placebo and again after 4 and 12 months of therapy. Recorded data were analyzed in a blinded fashion at a central core laboratory. Analysis of baseline clinical characteristics showed that patients enrolled in the substudy were generally representative of the SOLVD population, although prevention arm patients were slightly overrepresented in the substudy group (69.8% compared with 61.9% of remaining SOLVD patients). The enalapril group demonstrated significant reductions in the mitral annular E-wave-to-A-wave velocity ratio (due predominantly to a reduction in E-wave velocity), and this response was different from that seen in the placebo group (P=.030). Changes in the E-to-A ratio in the enalapril group correlated significantly with changes in plasma atrial natriuretic peptide (r=.56; P less than or equal to.01). LV end-diastolic and end-systolic volumes increased in placebo but not enalapril-treated patients, and the differences in response between the treatment groups were significant (P=.025 and .019, respectively). LV mass tended to increase in placebo patients and to be reduced in enalapril-treated patients, and the difference in response between the groups was highly significant (P less than or equal to.001).Conclusions These data demonstrate that enalapril attenuates progressive increases in LV dilatation and hypertrophy in patients with LV dysfunction. The results support the possibility that the favorable effects of enalapril reported in the SOLVD trials were related to inhibition of LV remodeling.