Guazzi M, Melzi G, Marenzi G C, Agostoni P
Istituto di Cardiologia dell'Università degli Studi, Centro di Studio per le Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche, Fondazione Monzino, IRCCS.
Clin Pharmacol Ther. 1999 Mar;65(3):319-27. doi: 10.1016/S0009-9236(99)70111-6.
The backward effects of left ventricular dysfunction include alterations in alveolar-capillary gas transfer and ventilation-perfusion coupling. Because the angiotensin-converting enzyme (ACE) is highly concentrated in the vascular endothelium of the lungs, we examined whether ACE inhibitors may influence the pulmonary function in patients with congestive heart failure.
In 20 patients with idiopathic cardiomyopathy, pulmonary function and exercise capacity were evaluated at baseline and 6 and 12 months after treatment with enalapril (10 mg twice a day) was started. The study also included 19 age- and sex-matched control subjects with mild primary hypertension and normal left ventricular function who were given enalapril as a standard treatment of high blood pressure.
In congestive heart failure, forced expiratory volume in 1 second, vital capacity, and total lung capacity did not vary significantly with enalapril; alveolar-capillary diffusion of carbon monoxide (DL(CO)) increased toward normal; exercise tolerance time, peak exercise oxygen uptake (peak VO2), minute ventilation and tidal volume (peak VT) also increased; and the ratio of volume of dead space (VD) to VT (peak VD/VT) at peak exercise reduced. Changes in peak VO2 showed a direct correlation with those in DL(CO) and an inverse correlation with those in peak VD/VT. Results at 6 and 12 months were comparable. Enalapril did not affect these variables in the control population.
In patients with idiopathic cardiomyopathy heart failure, but not in control subjects, gas transfer and ventilation-perfusion improved with ACE inhibition. These pulmonary changes may contribute to the associated increase in exercise tolerance.
左心室功能障碍的逆向影响包括肺泡-毛细血管气体交换和通气-灌注耦合的改变。由于血管紧张素转换酶（ACE）高度集中于肺血管内皮，我们研究了ACE抑制剂是否会影响充血性心力衰竭患者的肺功能。
对20例特发性心肌病患者，在开始使用依那普利（每日2次，每次10 mg）治疗的基线、治疗6个月和12个月时评估其肺功能和运动能力。该研究还纳入了19例年龄和性别匹配的轻度原发性高血压且左心室功能正常的对照受试者，给予依那普利作为高血压的标准治疗。
在充血性心力衰竭患者中，1秒用力呼气量、肺活量和肺总量在使用依那普利后无显著变化；一氧化碳肺泡-毛细血管弥散量（DL(CO)）趋向正常增加；运动耐受时间、运动峰值摄氧量（peak VO2）、分钟通气量和潮气量（peak VT）也增加；运动峰值时死腔容积（VD）与VT的比值（peak VD/VT）降低。peak VO2的变化与DL(CO)的变化呈正相关，与peak VD/VT的变化呈负相关。6个月和12个月时的结果具有可比性。依那普利对对照人群的这些变量无影响。
在特发性心肌病心力衰竭患者中，而非对照受试者中，ACE抑制可改善气体交换和通气-灌注。这些肺部变化可能有助于运动耐量的相关增加。
