硝酸异山梨酯和肼屈嗪固定剂量联合用药可使接受规范治疗的黑人心力衰竭患者的左心室重构进一步消退：A-HeFT研究结果
Isosorbide dinitrate and hydralazine in a fixed-dose combination produces further regression of left ventricular remodeling in a well-treated black population with heart failure: results from A-HeFT.
作者信息
Cohn Jay N, Tam S William, Anand Inder S, Taylor Anne L, Sabolinski Michael L, Worcel Manuel
机构信息
Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
出版信息
J Card Fail. 2007 Jun;13(5):331-9. doi: 10.1016/j.cardfail.2007.03.001.
BACKGROUND
Isosorbide dinitrate combined with hydralazine therapy compared with placebo in patients with heart failure resulted in a sustained increase in left ventricular (LV) ejection fraction (EF) indicative of regression of LV remodeling in the first Vasodilator-Heart Failure Trial (V-HeFT-I) in patients receiving only digoxin and diuretic. In the African-American Heart Failure Trial (A-HeFT) a fixed-dose combination resulted in a 43% reduction in mortality in 1050 black patients with heart failure already treated with recommended neurohormonal inhibiting drugs. Whether the fixed-dose combination produces a further regression of LV remodeling when added to renin-angiotensin and sympathetic inhibitors has not been documented.
METHODS AND RESULTS
Echocardiograms at baseline and 6 months after randomization to placebo or a fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) were analyzed in 678 A-HeFT participants in a core laboratory. LVEF rose by 2.8 EF units in the FDC I/H group versus 0.8% in the control group (P < .01), LV mass index fell by 7.4 g/m2 in the FDC I/H group versus an increase of 1.4 g/m2 in the placebo group (P < .05), LV diastolic transverse diameter fell by 2.2 mm in FDC I/H and was unchanged in placebo (P < .01), and the LV systolic and diastolic sphericity indices improved in the FDC I/H group but remained unchanged in the placebo group. The mean plasma B-type natriuretic peptide (BNP) also measured in a core laboratory fell in the FDC I/H group by 39 pg/mL compared with 8 pg/mL in the placebo group (P = .05).
CONCLUSIONS
A fixed-dose combination of I/H produces regression of LV remodeling when added to background therapy with renin-angiotensin and sympathetic inhibitors in black patients with heart failure. This remodeling benefit may explain at least in part the mortality reduction in A-HeFT.
背景
在仅接受地高辛和利尿剂治疗的患者中进行的首个血管扩张剂治疗心力衰竭试验（V-HeFT-I）显示，与安慰剂相比，硝酸异山梨酯联合肼苯哒嗪治疗可使心力衰竭患者的左心室（LV）射血分数（EF）持续升高，这表明LV重构出现了逆转。在非裔美国人心力衰竭试验（A-HeFT）中，一种固定剂量的联合用药使1050例已接受推荐的神经激素抑制药物治疗的黑人心力衰竭患者的死亡率降低了43%。当添加到肾素-血管紧张素和交感神经抑制剂中时，这种固定剂量的联合用药是否会使LV重构进一步逆转，目前尚无文献报道。
方法和结果
在一个核心实验室中，对678例A-HeFT参与者进行了随机分组，分别给予安慰剂或硝酸异山梨酯/肼苯哒嗪固定剂量联合用药（FDC I/H），并在基线和随机分组6个月后进行了超声心动图分析。FDC I/H组的左心室射血分数上升了2.8个EF单位，而对照组上升了0.8%（P < 0.01）；FDC I/H组的左心室质量指数下降了7.4 g/m²，而安慰剂组上升了1.4 g/m²（P < 0.05）；FDC I/H组的左心室舒张横径下降了2.2 mm，而安慰剂组无变化（P < 0.01）；FDC I/H组的左心室收缩和舒张球形指数得到改善，而安慰剂组保持不变。在核心实验室中测量的平均血浆B型利钠肽（BNP），FDC I/H组下降了39 pg/mL，而安慰剂组下降了8 pg/mL（P = 0.05）。
结论
在接受肾素-血管紧张素和交感神经抑制剂背景治疗的黑人心力衰竭患者中，添加I/H固定剂量联合用药可使LV重构出现逆转。这种重构益处可能至少部分解释了A-HeFT中死亡率的降低。
Zotero 插件