van den Heuvel A F, Dunselman P H, Kingma T, Verhorst P, Boomsma F, van Gilst W H, van Veldhuisen D J
Department of Cardiology/Thoraxcenter, University Hospital Groningen, The Netherlands.
J Am Coll Cardiol. 2001 Feb;37(2):470-4. doi: 10.1016/s0735-1097(00)01111-6.
We sought to study the effect of angiotensin-converting enzyme inhibition on exercise-induced myocardial ischemia.
Although angiotensin-converting enzyme inhibitors have been shown to reduce ischemic events after myocardial infarction, few data are available regarding their direct anti-ischemic effects in patients with coronary artery disease.
We studied 43 patients (average age 63 +/- 8 years) with exercise-induced myocardial ischemia (> or =0.1 mV ST depression, despite optimal beta blockade) and normal left ventricular function (ejection fraction >0.50). In a double-blind, placebo-controlled parallel design, patients were treated with angiotensin-converting enzyme inhibitor (enalapril 10 mg twice daily) or placebo. Assessments were made after three weeks (short-term) and 12 weeks (long-term).
At baseline, the groups were well matched for all clinical characteristics. After three weeks, there was a slight but not significant increase in time to 0.1 mV ST depression in both groups (p = NS); rate pressure product (RPP = heart rate x systolic blood pressure) was also unaffected. After 12 weeks, however, time to 0.1 mV ST depression further increased in the enalapril group (5.6 +/- 1.9 min) but was unchanged in the placebo group (4.4 +/- 1.3 min; p < 0.05 between groups). In contrast, RPP was not affected. Concentrations of both atrial and brain natriuretic peptides at peak exercise tended to be lower by enalapril, if compared to placebo (p = NS).
Angiotensin-converting enzyme inhibition may reduce exercise-induced myocardial ischemia in patients with normal left ventricular function. Further studies are needed to elucidate the mechanisms involved.
我们试图研究血管紧张素转换酶抑制对运动诱发的心肌缺血的影响。
尽管血管紧张素转换酶抑制剂已被证明可减少心肌梗死后的缺血事件，但关于其在冠心病患者中的直接抗缺血作用的数据却很少。
我们研究了43例运动诱发心肌缺血（尽管使用了最佳的β受体阻滞剂，仍有≥0.1 mV的ST段压低）且左心室功能正常（射血分数>0.50）的患者（平均年龄63±8岁）。采用双盲、安慰剂对照的平行设计，患者接受血管紧张素转换酶抑制剂（依那普利10 mg，每日两次）或安慰剂治疗。在三周（短期）和12周（长期）后进行评估。
在基线时，两组在所有临床特征方面匹配良好。三周后，两组至0.1 mV ST段压低的时间均有轻微但无显著增加（p =无显著性差异）；心率血压乘积（RPP =心率×收缩压）也未受影响。然而，12周后，依那普利组至0.1 mV ST段压低的时间进一步增加（5.6±1.9分钟），而安慰剂组则无变化（4.4±1.3分钟；两组间p<0.05）。相比之下，RPP未受影响。与安慰剂相比，运动高峰时心房和脑钠肽的浓度依那普利组有降低趋势（p =无显著性差异）。
血管紧张素转换酶抑制可能减轻左心室功能正常患者运动诱发的心肌缺血。需要进一步研究以阐明其中涉及的机制。
