Kleber F X, Niemöller L, Fischer M, Doering W
Division of Cardiology, Munich-Schwabing Hospital, Ludwig-Maximilians-University, Germany.
Am J Cardiol. 1991 Nov 18;68(14):121D-126D. doi: 10.1016/0002-9149(91)90269-q.
Angiotensin-converting enzyme (ACE) inhibition slowed the progression of congestive heart failure (CHF) in 170 patients who were randomly assigned to either captopril or placebo in the Munich Mild Heart Failure Trial. The two major end points were progression from New York Heart Association (NYHA) functional classes I, II, or III to class IV, despite optimal, adjusted standard therapy, and death due to CHF. The relative risk for progressive CHF with captopril therapy was 0.34 (95% confidence interval = 0.17-0.68; p = 0.01). A total of 52 prerandomization variables were tested to determine their contribution to disease progression. Logistic regression analysis revealed 5 independent risk factors for progressive CHF: NYHA class, left ventricular end-systolic diameter, need for diuretic, age, and cardiothoracic ratio. The presence of greater than 2 of these risk factors increased the odds ratio for progression to 8.13 (p less than 0.001) compared with the presence of 0-2 risk factors. However, the effectiveness of captopril in preventing progression was higher within the subgroup of patients who had less severe CHF: the odds ratio was 0.12 (95% confidence interval = 0.03-0.45; p less than 0.01) for patients in NYHA class I or II on captopril and was 0.83 for those in class III. We conclude that the severity of CHF, as represented by the above-defined risk factors, is directly related to the likelihood for the development of progressive heart failure. However, the less severe the heart failure, the more effective the treatment with captopril will be in preventing disease progression. Thus, ACE inhibition has considerable potential for improving the prognosis of patients with mild heart failure.
在慕尼黑轻度心力衰竭试验中，血管紧张素转换酶（ACE）抑制剂延缓了170例随机分配接受卡托普利或安慰剂治疗的充血性心力衰竭（CHF）患者的病情进展。两个主要终点是，尽管接受了优化的、调整后的标准治疗，但仍从纽约心脏协会（NYHA）心功能I、II或III级进展至IV级，以及因CHF死亡。接受卡托普利治疗的进行性CHF的相对风险为0.34（95%置信区间=0.17 - 0.68；p = 0.01）。共测试了52个随机分组前的变量，以确定它们对疾病进展的影响。逻辑回归分析揭示了进行性CHF的5个独立危险因素：NYHA分级、左心室收缩末期直径、使用利尿剂的必要性、年龄和心胸比率。与存在0 - 2个危险因素相比，存在超过2个这些危险因素会使进展的优势比增加至8.13（p小于0.001）。然而，卡托普利在预防病情进展方面，在CHF较轻的患者亚组中效果更高：接受卡托普利治疗的NYHA I或II级患者的优势比为0.12（95%置信区间=0.03 - 0.45；p小于0.01），III级患者的优势比为0.83。我们得出结论，以上述定义的危险因素所代表的CHF严重程度与进行性心力衰竭发生的可能性直接相关。然而，心力衰竭越轻，卡托普利治疗在预防疾病进展方面就越有效。因此，ACE抑制在改善轻度心力衰竭患者的预后方面具有相当大的潜力。
