EFFECT OF CAPTOPRIL ON PROGRESSIVE VENTRICULAR DILATATION AFTER ANTERIOR MYOCARDIAL-INFARCTION
EFFECT OF CAPTOPRIL ON PROGRESSIVE VENTRICULAR DILATATION AFTER ANTERIOR MYOCARDIAL-INFARCTION
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DOI：
10.1056/nejm198807143190204
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发表时间：
1988-07-14
影响因子：
158.5
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
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作者：
PFEFFER, MA;LAMAS, GA;BRAUNWALD, E
我们总结了一项双盲、安慰剂对照试验，以确定心肌梗死后恢复期晚期心室扩张是否持续，以及卡托普利治疗是否改变了这一过程。59例首次前壁心肌梗死且放射性核素射血分数为45%或更低的患者在梗死后11至31天接受了心导管插入术，当时他们没有明显的充血性心力衰竭。他们被随机分配到安慰剂组或卡托普利组，并随访一年。重复进行导管插入术，以评估血流动力学功能和左心室容积的间隔变化。38名男性患者每三个月进行一次最大运动平板试验。在基线时，临床、血流动力学或定量心室造影变量未检测到差异。在一年的随访中，左心室舒张末期容积平均增加[. ±.]。SEM]的21 .+-. 8 ml（P < 0.02），但仅增加了10 .卡托普利组6 ml（P无显著性差异）。安慰剂组左心室充盈压仍升高，而开搏通组左心室充盈压降低（P < 0.01）。在36例因冠状动脉左前降支持续闭塞而有心室扩大高风险的患者中，开搏通阻止了心室进一步扩大（P < 0.05）。服用巯甲丙脯酸的患者运动能力也有所提高（P < 0.05）。初步研究表明，前壁心肌梗死后，心室扩大是进行性的，卡托普利可减弱这一过程，降低充盈压，提高运动耐量。
We concluded a double-blind, placebo-controlled trial to determine whether ventricular dilatation cointinues during the late convalescent phase after myocardial infarction and whether therapy with captopril alters this process. Fifty-nine patients with a first anterior myocardial infarction and a radionuclide ejection fraction of 45 percent or less underwent cardiac catheterization 11 to 31 days after infarction, when they were not in overt congestive heart failure. They were randomly assigned to placebo or captopril and were followed for one year. A repeat catheterization was performed to evaluate interval changes in hemodynamic function and left ventricular volume. Thirty-eight male patients were evaluated with maximal-exercise treadmill tests every three months. No differences were detected at base line in clinical, hemodynamic, or quantitative ventriculographic variables. During one year of follow-up, the end-diastolic volume of the left ventricle increased by a mean [.+-. SEM] of 21 .+-. 8 ml (P < 0.02) in the placebo group, but by only 10 .+-. 6 ml (P not significant) in the captopril group. The left ventricular filling pressure remained elevated with placebo but decreased (P < 0.01) with captopril. In a subset of 36 patients who were at high risk for ventricular enlargement because they had persistent occlusion of the left anterior descending coronary artery, captopril prevented further ventricular dilatation (P < 0.05). Patients given captopril also had increased exercise capacity (P < 0.05). This preliminary study indicates that after anterior myocardial infarction, ventricular enlargement is progressive and that captopril may attenuate this process, reduce filling pressures, and improve exercise tolerance.