Akbulut Tamer, Akgöz Haldun, Dayi Sennur Unal, Celik Seden Erten, Gürkan Ufuk, Tayyareci Gülşah
Siyami Ersek Cardiothoracic Surgical Center, Cardiology Clinic, Istanbul, Turkey.
Angiology. 2006 Mar-Apr;57(2):181-6. doi: 10.1177/000331970605700207.
The aim of this study was to evaluate the effects of the combination of enalapril and losartan in patients with left ventricular systolic dysfunction by means of cardiopulmonary exercise test (CPET). Patients with left-ventricular systolic dysfunction and ejection fractions of 40% or less were included to the study. All patients were under the treatment of enalapril 20 mg once daily. The study group consisted of 20 patients (18 men, 2 women; mean age +/- standard deviation: 62.4 +/-6.5 years) and the comparison group consisted of 10 (8 men, 2 women; mean age 59.3 +/-11.9 years). The dose of 50 mg of losartan once daily was given additionally to the study patients. Breath-by-breath CPET was performed before administration of losartan and then 6-8 weeks later in the study group and 2 times with an interval of 6-8 weeks in the control group without any change in the treatment protocol. In the study group the average exercise times were 361 +/-192 and 454 +/-205 seconds (p = 0.001) before and after the study. Peak oxygen consumption ( VO2) values were 1,209 +/-366 and 1,284 +/-398 mL/minute before and after the study (p = 0.01). Anaerobic threshold VO2 values were 785 +/-187 and 855 +/-217 mL/minute before and after the study, respectively (p = 0.01). Peak heart rates (HR) were 141 +/-28 and 143 +/-22/minute (p = 0.35); peak VO2/HR values were 9.02 +/-3.1 and 9.3 +/-3 mL/minute (p = 0.4) before and after the study, respectively. On the other hand, in the control group, average exercise times were 556 +/-250 and 528 +/-251 seconds (p = 0.8); peak VO2 values were 1,502 +/-537 and 1,450 +/-501 mL/minute (p = 0.2); and anaerobic threshold VO2 values were 1,005 +/-338 and 975 +/-319 mL/min (p = 0.7), before and after the study respectively. At the highest comparable exercise stage for both tests in the study group the expired volume/oxygen consumption ( VE/ VO2) ratio declined from 35.1 +/-6.2 to 32.4 +/-5.6 (p = 0.007). VE values declined from 37.5 +/-10.9 to 33.9 +/-10.1 L (p = 0.02); heart rate declined from 140 +/-27 to 132 +/-21/minute (p = 0.02). No significant change was observed in the mentioned values for the control group. Addition of losartan to the standard therapy in patients with left ventricular systolic dysfunction improved exercise capacity and caused lower heart rate and ventilation requirements for the same exercise level.
本研究旨在通过心肺运动试验（CPET）评估依那普利和氯沙坦联合用药对左心室收缩功能不全患者的影响。左心室收缩功能不全且射血分数为40%或更低的患者被纳入本研究。所有患者均接受每日一次20 mg依那普利的治疗。研究组由20名患者组成（18名男性，2名女性；平均年龄±标准差：62.4±6.5岁），对照组由10名患者组成（8名男性，2名女性；平均年龄59.3±11.9岁）。研究组患者额外给予每日一次50 mg氯沙坦的剂量。在研究组中，于给予氯沙坦前及给药后6 - 8周进行逐次呼吸CPET，在对照组中，治疗方案无任何变化，每隔6 - 8周进行2次CPET。研究组研究前后的平均运动时间分别为361±192秒和454±205秒（p = 0.001）。研究前后的峰值耗氧量（VO₂）值分别为1209±366和1284±398 mL/分钟（p = 0.01）。无氧阈VO₂值在研究前后分别为785±187和855±217 mL/分钟（p = 0.01）。峰值心率（HR）分别为141±28和143±22/分钟（p = 0.35）；研究前后的峰值VO₂/HR值分别为9.02±3.1和9.3±3 mL/分钟（p = 0.4）。另一方面，对照组的平均运动时间分别为556±250和528±251秒（p = 0.8）；峰值VO₂值分别为1502±537和1450±501 mL/分钟（p = 0.2）；无氧阈VO₂值在研究前后分别为1005±338和975±319 mL/分钟（p = 0.7）。在研究组的两项测试中，在最高可比运动阶段，呼出气体量/耗氧量（VE/VO₂）比值从35.1±6.2降至32.4±5.6（p = 0.007）。VE值从37.5±10.9降至33.9±10.1 L（p = 0.02）；心率从140±27降至132±21/分钟（p = 0.02）。对照组的上述值未观察到显著变化。对于左心室收缩功能不全患者，在标准治疗基础上加用氯沙坦可改善运动能力，并在相同运动水平下降低心率和通气需求。
