尼可地尔与依那普利对慢性风湿性重度二尖瓣反流的有益作用：六个月随访超声心动图研究

Beneficial effects of nicorandil versus enalapril in chronic rheumatic severe mitral regurgitation: six months follow up echocardiographic study.

作者信息

Gupta D K, Kapoor A, Garg N, Tewari S, Sinha N

机构信息

Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

出版信息

J Heart Valve Dis. 2001 Mar;10(2):158-65.

PMID:11297201

Abstract

BACKGROUND AND AIM OF THE STUDY

It is possible that vasodilator therapy may retard left ventricular (LV) dilatation and functional deterioration in chronic mitral regurgitation (MR). The study objectives were to evaluate comparatively the efficacy of nicorandil (a new, balanced vasodilator) and enalapril therapy on LV volume, mass and function in mildly symptomatic, chronic rheumatic severe MR.

METHODS

Eighty-seven mildly symptomatic rheumatic patients with severe MR were enrolled in this prospective, randomized study. All patients underwent serial echocardiography study at entry, and again at six months. Eighty patients completed the study.

RESULTS

At six months, the nicorandil and enalapril patient groups each had a significant reduction in LV end-systolic volume index (57.4 +/- 24.8 versus 43.2 +/- 20.7 ml/m2, p = 0.003; 50.0 +/- 19.0 versus 40.4 +/- 14.2 ml/m2, p = 0.006, respectively) and LV mass index (218.0 +/- 88.0 versus 188.0 +/- 76.0 g/m2, p = 0.05; 217.2 +/- 48.0 versus 186.2 +/- 45.0 g/m2, p = 0.002 respectively). Both nicorandil and enalapril caused significant improvement in ejection fraction (63.8 +/- 7.0 versus 71.0 +/- 6.7%, p <0.0001; 63.2 +/- 6.9 versus 67.5 +/- 6.4%, p = 0.002, respectively) and a reduction in LV end-systolic stress (152.9 +/- 29.0 versus 126.0 +/- 25.0 dyne/cm2, p = 0.001; 150.0 +/- 30.2 versus 138.0 +/- 29.0 dyne/cm2, p = 0.002, respectively). However, nicorandil caused a greater reduction in absolute LV end-systolic volume index (13.3 +/- 10.1 versus 9.6 +/- 5.9 ml/m2, p = 0.02), and a greater improvement in absolute ejection fraction (7.2 +/- 4.7 versus 4.2 +/- 2.6%, p = 0.0005) than enalapril.

CONCLUSION

It is concluded that nicorandil is equivalent to enalapril in improving LV volume, mass, end-systolic stress and ejection fraction in mildly symptomatic chronic rheumatic severe mitral regurgitation over a period of six months.

摘要

研究背景与目的

血管扩张剂治疗可能会延缓慢性二尖瓣反流（MR）患者左心室（LV）扩张及功能恶化。本研究目的是比较尼可地尔（一种新型平衡血管扩张剂）与依那普利治疗对轻度症状性慢性风湿性重度MR患者左心室容积、质量及功能的疗效。

方法

87例轻度症状性风湿性重度MR患者纳入本前瞻性随机研究。所有患者在入组时及6个月时均接受系列超声心动图检查。80例患者完成研究。

结果

6个月时，尼可地尔组和依那普利组患者的左心室收缩末期容积指数均显著降低（分别为57.4±24.8 vs 43.2±20.7 ml/m²，p = 0.003；50.0±19.0 vs 40.4±14.2 ml/m²，p = 0.006），左心室质量指数也显著降低（分别为218.0±88.0 vs 188.0±76.0 g/m²，p = 0.05；217.2±48.0 vs 186.2±45.0 g/m²，p = 0.002）。尼可地尔和依那普利均使射血分数显著改善（分别为63.8±7.0 vs 71.0±6.7%，p<0.0001；63.2±6.9 vs 67.5±6.4%，p = 0.002），左心室收缩末期压力降低（分别为152.9±29.0 vs 126.0±25.0达因/cm²，p = 0.001；150.0±30.2 vs 138.0±29.0达因/cm²，p = 0.002）。然而，与依那普利相比，尼可地尔使左心室收缩末期容积指数的绝对降低幅度更大（13.3±10.1 vs 9.6±5.9 ml/m²，p = 0.02），射血分数的绝对改善幅度更大（7.2±4.7 vs 4.