Impact of converting enzyme inhibition on progression of chronic heart failure: results of the Munich Mild Heart Failure Trial.
Impact of converting enzyme inhibition on progression of chronic heart failure: results of the Munich Mild Heart Failure Trial.
复制标题
转化酶抑制对慢性心力衰竭进展的影响：慕尼黑轻度心力衰竭试验的结果。
作者：
F. Kleber;Lisa Niemoller;W. Doering
目的——神经激素激活对充血性心力衰竭的病理生理有重要影响。慕尼黑轻度心力衰竭试验旨在验证通过抑制血管紧张素转换酶干扰肾素-血管紧张素系统有利于影响心力衰竭的自然史的假设。设计和患者——170例患者，中位纽约心脏协会（NYHA） II级，随机分为25 mg卡托普利/ 2次/天或安慰剂双盲治疗和标准治疗，中位观察期为2.7年。主要结局指标：经最佳调整标准治疗的心衰进展至NYHA IV级，因进行性心衰导致的死亡和猝死。结果：卡托普利组9例（10.8%）患者心力衰竭进展为IV级，安慰剂组23例（26.4%）患者心力衰竭进展为IV级（p = 0.01）。卡托普利组至该终点的平均生存时间延长223天（Kaplan-Meier生命表分析；p = 0.02）。此外，逐渐恶化为严重心力衰竭是总死亡率和心力衰竭死亡的有力预测指标；80%因进行性心力衰竭导致的死亡发生在这个终点之后。卡托普利组因进行性心力衰竭导致的死亡人数少于安慰剂组（4 vs 11; p = 0.10），但猝死人数相似（11 vs 10）。在卡托普利组和安慰剂组中，进行性心力衰竭是18.2%和50%的死亡原因。总心力衰竭事件（功率计算的终点）在安慰剂组中也更常见（19 vs 32），但没有显著性差异。两组总死亡率相似（83例中有22例vs 87例中有22例）。结论：在充血性心力衰竭早期，血管紧张素转换酶抑制与标准治疗相结合可以减缓心力衰竭的进展，从而有利地改变该疾病的自然史。
OBJECTIVE--Neurohormonal activation has major impact on the pathophysiology of congestive heart failure. The Munich Mild Heart Failure Trial was designed to test the hypothesis that interference with the renin-angiotensin system by angiotensin converting enzyme inhibition favourably influences the natural history of heart failure. DESIGN AND PATIENTS--170 patients, median New York Heart Association (NYHA) class II, were randomised to double blind treatment with 25 mg captopril twice a day or placebo in addition to standard treatment for a median observation period of 2.7 years. MAIN OUTCOME MEASURES--Progression of heart failure to NYHA class IV on an optimally adjusted standard treatment, death due to progressive heart failure, and sudden death. RESULTS--Heart failure progressed to class IV in nine patients (10.8%) treated with captopril and in 23 patients (26.4%) treated with placebo (p = 0.01). The mean survival time until this end point was 223 days longer in the captopril group (Kaplan-Meier life table analysis; p = 0.02). Also, progressive deterioration to severe heart failure was a powerful predictor of total mortality and death from heart failure; 80% of deaths due to progressive heart failure occurred after this end point. There were fewer deaths caused by progressive heart failure in the captopril group than in the placebo group (4 v 11; p = 0.10) but similar numbers of sudden deaths (11 v 10). Progressive heart failure was the cause of death in 18.2% of all deaths in the captopril group and 50% in the placebo group. Total heart failure events (the end point on which power calculation was based) were also more common in the placebo group (19 v 32 events) but not significantly so. Total mortality was similar to both groups (22 of 83 v 22 of 87). CONCLUSIONS--Angiotensin converting enzyme inhibition in conjunction with standard therapy early in the course of congestive heart failure slowed the progress of heart failure and thus favourably altered the natural history of the disease.
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影响因子：
37.8
作者：
PFEFFER, MA;PFEFFER, JM;FINN, P
通讯作者：
FINN, P
影响因子：
158.5
作者：
COHN, JN;LEVINE, TB;RECTOR, T
通讯作者：
RECTOR, T
影响因子：
37.8
作者：
LEE, WH;PACKER, M
通讯作者：
PACKER, M
影响因子：
158.5
作者：
PFEFFER, MA;LAMAS, GA;BRAUNWALD, E
通讯作者：
BRAUNWALD, E