心肌梗死后左心室射血分数为40%-50%与25%-39%的患者的左心室重构。尼索地平治疗的影响？来自DEFIANT II研究的一项超声心动图亚组研究。

Left ventricular remodelling in post-myocardial infarction patients with left ventricular ejection fraction 40-50% vs 25-39%. Influence of nisoldipine treatment? An echocardiographic substudy from the DEFIANT II study.

作者信息

Otterstad J E, Lubsen K, Parker A, Kirwan B, Plappert T, St John Sutton M G

机构信息

Division of Cardiology, Vestfold Central Hospital, Tønsberg, Norway.

出版信息

Scand Cardiovasc J. 1999;33(4):234-41. doi: 10.1080/14017439950141678.

DOI:10.1080/14017439950141678

PMID:10517211

Abstract

OBJECTIVE

Left ventricular (LV) remodelling following acute myocardial infarction has generally been studied in patients with LV ejection fraction (EF) < 40%, and it has been shown that this process can be attenuated by ACE inhibitors. Little is known regarding LV remodelling in patients with LVEF > or = 40% or the effects of treatment in this patient cohort. The DEFIANT II study (Doppler Flow and Echocardiography in Functional cardiac insufficiency) included 542 post-infarction patients with LVEF 25-50% without overt heart failure within 13 days following acute myocardial infarction (AMI). They were then randomized to nisoldipine coat-core (CC) or placebo and followed up for 6 months.

DESIGN

Two-dimensional echoes were obtained after 8 (5-13) days and 6 months following AMI.

SETTING

LV end diastolic (ED) and end systolic (ES) volumes (V) were calculated in 503 patients with technically satisfactory paired echoes using the biplabe method of discs in a core laboratory.

SUBJECTS

Group A. 217 patients with baseline EF 40-50%, of whom 112 were randomized to nisoldipine and 104 to placebo (one patient was taken off study medication). Group B. 286 patients with EF 25-39%, of whom 145 were randomized to nisoldipine and 141 to placebo.

RESULTS

LVEDV was 175 (+/-45) ml in Group A vs 203 (+/-49) ml in Group B (p = 0.001) at baseline and 184 (+/-48) ml vs 213 (+/-56) ml (p = 0.001), respectively, at 6 months. LVESV at baseline was 97 (+/-42) ml in Group A vs 133 (+/-37) ml in Group B (p = 0.001), and 106 (+/-34) ml vs 134 (+/-45) ml (p = 0.001) at 6 months, respectively. The increase of LVESV was 9 (+/-29) ml in Group A vs 2 (+/-35) ml in Group B (p = 0.007). LVEF decreased by 2 (+/-6)% in Group A vs an increase of 3 (+/-6)% in Group B (p = 0.001). Treatment with nisoldipine had no influence on LV volumes in either of the two groups or in the total study group.

CONCLUSION

LV dilatation 6 months following AMI in patients with EF 40-50% was similar in end diastole, but more pronounced in end systole vs patients with EF 25-39%. LV remodelling did not change significantly after nisoldipine treatment.

摘要

目的

急性心肌梗死后左心室（LV）重构通常是在左心室射血分数（EF）<40%的患者中进行研究，并且已经表明这一过程可被血管紧张素转换酶抑制剂减弱。对于LVEF>或=40%的患者的LV重构情况或该患者群体的治疗效果知之甚少。DEFIANT II研究（功能性心脏功能不全中的多普勒血流与超声心动图）纳入了542例急性心肌梗死（AMI）后13天内LVEF为25 - 50%且无明显心力衰竭的梗死患者。然后将他们随机分为尼索地平包衣片（CC）组或安慰剂组，并随访6个月。

设计

在AMI后8（5 - 13）天和6个月时获取二维超声心动图。

设置

在核心实验室中，使用双平面圆盘法在503例技术上获得满意配对回声的患者中计算左心室舒张末期（ED）和收缩末期（ES）容积（V）。

受试者

A组。217例基线EF为40 - 50%的患者，其中112例随机分配至尼索地平组，104例分配至安慰剂组（1例患者退出研究用药）。B组。286例EF为25 - 39%的患者，其中145例随机分配至尼索地平组，141例分配至安慰剂组。

结果

基线时，A组的LVEDV为175（±45）ml，B组为203（±49）ml（p = 0.001）；6个月时，分别为184（±48）ml和213（±56）ml（p = 0.001）。基线时，A组的LVESV为97（±42）ml，B组为133（±37）ml（p = 0.001）；6个月时，分别为106（±34）ml和134（±45）ml（p = 0.001）。A组LVESV的增加为9（±29）ml，B组为2（±35）ml（p = 0.007）。A组的LVEF下降了2（±6）%，而B组增加了3（±6）%（p = 0.001）。尼索地平治疗对两组中的任何一组或整个研究组的LV容积均无影响。