Determinants of clinical response and survival in patients with congestive heart failure treated with captopril.
Determinants of clinical response and survival in patients with congestive heart failure treated with captopril.
复制标题
卡托普利治疗充血性心力衰竭患者临床反应和生存的决定因素。
DOI：
10.1016/0002-8703(82)90043-6
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发表时间：
1982
影响因子：
4.8
通讯作者：
Ryan,TJ
中科院分区：
文献类型：
--
作者：
Creager,MA;Faxon,DP;Halperin,JL;Melidossian,CD;McCabe,CH;Schick,EC;Ryan,TJ
通过心导管检查、平板运动、核素心肌显像、超声心动图和心脏病学，对36例难治性慢性充血性心力衰竭（CHF）患者进行了为期18个月的长期非卧床卡托普利（CPT）治疗的疗效评价。治疗2个月后，观察到63%的患者（20/32）临床改善至纽约心脏协会功能I级或II级; 18个月时，63%的患者（10/16）CHF症状持续改善。早期随访时，64%的患者（25例中的16例）的运动耐量增加，晚期随访时，79%的患者（14例中的11例）的运动耐量增加。单因素分析显示，CPT前后的每搏作功指数（SWI）和CPT后的心脏指数与良好的长期临床反应相关。14名CHF患者（39%）在18个月随访期间死亡。单变量分析显示，治疗前SWI、右心房压力、血浆去甲肾上腺素浓度和超声心动图缩短分数是死亡率的重要预测因素。多因素分析表明SWI是生存的主要决定因素：SWI小于32 gm · m/m2的CHF患者的18个月累积生存率为44%，而SWI大于32 gm · m/m2的患者为88%。因此，CPT导致晚期CHF患者的症状和功能持续改善，但死亡率仍然很高，主要与心功能不全的严重程度有关。
The efficacy of chronic ambulatory captopril (CPT) therapy was evaluated over an 18-month period in 36 patients with refractory chronic congestive heart failure (CHF) by cardiac catheterization, treadmill exercise, nuclear scintigraphy, echocardiography, and symptomatology. Clinical improvement to New York Heart Association functional class I or class II was observed in 63% of the patients (20 of 32) after 2 months of treatment; this amelioration of CHF symptoms was sustained in 63% of the patients (10 of 16) at 18 months. Exercise tolerance increased in 64% of the patients (16 of 25) at early follow-up and in 79% (11 of 14) at late follow-up. Univeriate analysis revealed that the pre- and post-CPT stroke work indices (SWI) and the post-CPT cardiac index related to favorable long-term clinical response. Fourteen CHF patients (39%) died during the 18-month follow-up. Univariate analysis revealed that the pretreatment SWI, right atrial pressure, plasma norepinephrine concentration, and echocardiographic shortening fraction were significant predictors of mortality. Multivariate analysis indicated that the SWI was the principal determinant of survival: the 18-month cumulative survival rate for CHF patients with a SWI less than 32 gm · m/m2was 44% compared to 88% when the SWI was greater than 32 gm · m/m2. Thus, CPT results in sustained symptomatic and functional improvement in patients with advanced CHF, but the mortality remains high and is primarily related to the severity of cardiac dysfunction.