Rivera Ivan Romero, Moisés Valdir Ambrósio, Carvalho Antonio Carlos, de Paola Angelo Amato V
Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2003 Feb;80(2):144-9, 138-43. doi: 10.1590/s0066-782x2003000200003. Epub 2003 Feb 25.
To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR).
We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure.
No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase.
The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.
研究轻度症状慢性二尖瓣反流（MR）患者在药物影响下左心室收缩功能和瓣膜反流的超声心动图参数。
我们对12例平均年龄12.5岁的MR患者进行了一项双盲安慰剂对照研究，这些患者被随机分为4个阶段：A）地高辛；B）依那普利；C）地高辛 + 依那普利；D）安慰剂。每个阶段给药30天，并分析以下变量：缩短分数和射血分数、左心室壁应力指数、左心室子午线收缩末期壁应力、多普勒衍生的左心室压力上升平均速率（平均dP/dt）、每搏量和MR反流束面积。分析的临床变量为心率和体动脉压。
分析的临床变量未观察到显著变化。与安慰剂阶段相比，用药阶段的缩短分数和射血分数、平均dP/dt和每搏量显著增加，左心室壁应力指数、左心室子午线收缩末期壁应力和二尖瓣反流束面积减小。
在轻度症状慢性MR患者中，单独使用地高辛或依那普利可显著改善左心室收缩功能参数并降低MR程度。然而，药物联合使用并未显示出更好的效果。
