Tardif Jean-Claude, Mercier Lise-Andrée, Théroux Pierre
Department of Medicine, Montreal Heart Institute, Montreal, Quebec.
Can J Cardiol. 2004 Mar 1;20(3):317-22.
To evaluate the effects of inhibition of the Na+/H+ exchanger (NHE) on regional left ventricular dysfunction in patients with a non-ST elevation acute coronary syndrome (ACS) BACKGROUND: NHE inhibition protects against myocardial necrosis and stunning in ischemia-reperfusion models.
In a substudy of the GUARd During Ischemia Against Necrosis (GUARDIAN) trial, 141 patients with an ACS and wall motion abnormalities on a baseline echocardiogram underwent repeated studies after 48 h and 36 days to determine the extent of early and late recovery of ventricular function. Patients were randomized to cariporide 20 mg, 80 mg or 120 mg intravenously three times per day or placebo for two to seven days. The wall motion score index improved from baseline to day 36 by 0.13+/-0.21, 0.16+/-0.34 and 0.15+/-0.28, respectively, in the cariporide groups, and by 0.10+/-0.16 with placebo (P=0.57). From baseline to 48 h, the wall motion score index decreased by 0.04+/-0.16, 0.08+/-0.20 and 0.03+/-0.22, respectively, for the cariporide groups and by 0.03+/-0.11 with placebo (P=0.09); the number of abnormal chords (centreline method) decreased by 11.2+/-24.0, 9.5+/-24.3 and 8.1+/-27.9, respectively, in the cariporide groups compared with an increase of 0.6+/-20.0 with placebo (P=NS).
No significant benefit of NHE inhibition could be detected in ACS patients in the GUARDIAN trial.
评估抑制钠氢交换体（NHE）对非ST段抬高型急性冠状动脉综合征（ACS）患者局部左心室功能障碍的影响。背景：在缺血再灌注模型中，抑制NHE可防止心肌坏死和心肌顿抑。
在“缺血时保护心肌免于坏死”（GUARDIAN）试验的一项子研究中，141例基线超声心动图显示有ACS且存在室壁运动异常的患者，在48小时和36天后接受了重复检查，以确定心室功能早期和晚期恢复的程度。患者被随机分为每日静脉注射三次20毫克、80毫克或120毫克卡里波罗或安慰剂，持续两到七天。卡里波罗组从基线到第36天，室壁运动评分指数分别改善0.13±0.21、0.16±0.34和0.15±0.28，安慰剂组改善0.10±0.16（P = 0.57）。从基线到48小时，卡里波罗组室壁运动评分指数分别下降0.04±0.16、0.08±0.20和0.03±0.22，安慰剂组下降0.03±0.11（P = 0.09）；卡里波罗组异常弦数（中心线法）分别减少11.2±24.0、9.5±24.3和8.1±27.9，而安慰剂组增加0.6±20.0（P无统计学意义）。
在GUARDIAN试验的ACS患者中，未检测到抑制NHE有显著益处。
