Kleber F X, Doering W
Abteilung für Kardiologie, Krankenhaus München-Schwabing, Akademisches Lehrkrankenhaus, der Ludwig-Maximilians-Universität München.
Herz. 1991 Sep;16 Spec No 1:283-93.
The Munich Mild Heart Failure Trial (MHFT) investigated the influences of ACE-inhibition on progression of congestive heart failure (CHF). Major end points were progression of CHF from New York Heart Association (NYHA) functional classes I to III to NYHA functional class IV despite optimal adjusted standard therapy and death due to congestive heart failure, i.e. death due to pump failure or sudden death. 170 patients were randomly assigned to treatment with either captopril (n = 83) 25 mg b.i.d. or placebo in addition to standard therapy for a median observation period of 2.7 years. The major result of this trial was the decrease in the relative risk for progressive heart failure by captopril therapy to 34% (95% confidence interval 17 to 68%; p = 0.01). Though total mortality was not reduced, death due to pump failure was found considerably less often on captopril than on placebo (18.2 vs 50% of total deaths in each group). In addition this report describes influences of captopril therapy on left ventricular size and function, heart size on X-ray, influences on symptomatology, electrolytes, ventricular arrhythmias, on concomitant therapy as well as effects in various subgroups. The major finding of the trial--the influence on progression of CHF--was independent of the underlying cardiac disease and was consistent in subgroups with different etiology of heart failure. Captopril blunted the increase in norepinephrine levels usually seen with increasing severity of congestive heart failure. There was a significant increase in serum sodium and potassium levels in the captopril treated group. Left ventricular size and function were well preserved in the patients still on randomized therapy after two years. No effects of therapy on ventricular ectopic activity were found in a subgroup of 93 patients that had had Holter monitoring.
Captopril has marked effects on progression of disease and reduces the likelihood of progressive heart failure in patients with mild symptoms. Several indices of unfavourable prognosis are either improved (sodium, norepinephrine, angiotensin II) or stabilized (left ventricular function). Thus ACE-inhibitors are to be considered for all patients requiring medical therapy for congestive heart failure.
慕尼黑轻度心力衰竭试验（MHFT）研究了血管紧张素转换酶抑制剂（ACEI）对充血性心力衰竭（CHF）进展的影响。主要终点是尽管进行了最佳调整的标准治疗，但CHF仍从纽约心脏协会（NYHA）心功能I级进展至III级再进展至IV级，以及因充血性心力衰竭导致的死亡，即因泵衰竭或猝死导致的死亡。170例患者被随机分配接受卡托普利治疗（n = 83），每日两次，每次25 mg，或接受安慰剂治疗，同时接受标准治疗，中位观察期为2.7年。该试验的主要结果是，卡托普利治疗使进行性心力衰竭的相对风险降低至34%（95%置信区间为17%至68%；p = 0.01）。尽管总死亡率没有降低，但发现因泵衰竭导致的死亡在卡托普利治疗组中比安慰剂组少得多（每组总死亡人数中分别为18.2%和50%）。此外，本报告描述了卡托普利治疗对左心室大小和功能、X线心脏大小、症状、电解质、室性心律失常、伴随治疗的影响以及在各个亚组中的效果。该试验的主要发现——对CHF进展的影响——与潜在的心脏疾病无关，并且在心力衰竭病因不同的亚组中是一致的。卡托普利抑制了通常随着充血性心力衰竭严重程度增加而出现的去甲肾上腺素水平的升高。卡托普利治疗组的血清钠和钾水平显著升高。两年后仍接受随机治疗的患者的左心室大小和功能得到了很好的保留。在接受动态心电图监测的93例患者亚组中，未发现治疗对室性异位活动有影响。
卡托普利对疾病进展有显著影响，并降低了症状较轻患者发生进行性心力衰竭的可能性。几个不良预后指标要么得到改善（钠、去甲肾上腺素、血管紧张素II），要么趋于稳定（左心室功能）。因此，对于所有需要药物治疗充血性心力衰竭的患者，都应考虑使用ACEI。
