Abdulla Jawdat, Pogue Janice, Abildstrøm Steen Z, Køber Lars, Christensen Erik, Pfeffer Marc A, Yusuf Salim, Torp-Pedersen Christian
Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.
Eur J Heart Fail. 2006 Jan;8(1):90-6. doi: 10.1016/j.ejheart.2005.03.006. Epub 2005 Jul 27.
The effect of angiotensin converting enzyme (ACE) inhibitors on symptoms in patients with left ventricular systolic dysfunction (LVSD) is controversial.
To perform a meta-analysis of studies evaluating effect of ACE inhibitors on New York Heart Association (NYHA) class in patients with LVSD.
Individual data from 10389 patients in NYHA classes I-IV from four large long-term studies (2-4-year follow-up) and summary data from 2302 patients in NYHA classes II-IV from 16 short-term studies (3 months follow-up) were meta-analysed to assess changes in NYHA class.
The large long-term studies showed a significant improvement in the worst NYHA classes (classes II-IV compared to class I) in the ACE inhibitor arm versus placebo, odds ratio (OR) = 0.875 (0.811-0.943) p = 0.0005. This effect was only present in studies which included patients with chronic heart failure and was particularly pronounced on deterioration to the worst NYHA class IV, OR = 0.66 (0.52-0.84) p = 0.001. There was no effect in the studies which included patients after myocardial infarction. The short-term chronic heart failure studies showed a significant improvement in NYHA class; OR for improvement of at least one NYHA class was 2.11 (1.48-2.98, 95% CI) p < 0.0001.
ACE inhibition significantly improves symptomatic status measured as NYHA classification in patients with chronic heart failure.
血管紧张素转换酶（ACE）抑制剂对左心室收缩功能障碍（LVSD）患者症状的影响存在争议。
对评估ACE抑制剂对LVSD患者纽约心脏协会（NYHA）心功能分级影响的研究进行荟萃分析。
对四项大型长期研究（随访2 - 4年）中10389例NYHA心功能I - IV级患者的个体数据以及16项短期研究（随访3个月）中2302例NYHA心功能II - IV级患者的汇总数据进行荟萃分析，以评估NYHA心功能分级的变化。
大型长期研究显示，与安慰剂相比，ACE抑制剂组在NYHA最差心功能分级（II - IV级与I级相比）方面有显著改善，优势比（OR） = 0.875（0.811 - 0.943），p = 0.0005。这种效果仅在纳入慢性心力衰竭患者的研究中出现，并且在恶化为最差的NYHA IV级时尤为明显，OR = 0.66（0.52 - 0.84），p = 0.001。在纳入心肌梗死患者的研究中没有效果。短期慢性心力衰竭研究显示NYHA心功能分级有显著改善；至少改善一个NYHA心功能分级的OR为2.11（1.48 - 2.98，95%CI），p < 0.0001。
ACE抑制可显著改善以NYHA分级衡量的慢性心力衰竭患者的症状状态。
