Pfeffer M A, Braunwald E
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 1991 Nov 18;68(14):127D-131D. doi: 10.1016/0002-9149(91)90270-u.
The dilation and distortion of the left ventricle that may occur as a consequence of myocardial infarction are associated with a heightened risk for adverse cardiovascular events. Infarcts that are extensive, transmural, and involve the apex as well as persistently occluded, infarct-related coronary arteries are predisposing factors for ventricular enlargement. Infarct expansion is an early component of the overall process of volume enlargement, which later continues as a volume overload hypertrophy of the remaining myocardium. Therapy to limit myocardial necrosis has been associated with the preservation of a more normal ventricular architecture. The late phase of ventricular remodeling has also been shown to be amendable to therapy, as chronic administration of angiotensin-converting enzyme (ACE) inhibitors has been associated with a reduction in the extent of ventricular dilation. There is currently a great deal of clinical investigative interest not only in whether ACE inhibition therapy following acute myocardial infarction will result in preservation of ventricular volume and topography, but, more importantly, whether it will lead to an improvement in clinical outcome.
心肌梗死可能导致的左心室扩张和变形与心血管不良事件风险增加相关。广泛、透壁且累及心尖的梗死灶，以及持续闭塞的梗死相关冠状动脉，是心室扩大的易感因素。梗死扩展是心室容积增大总体过程的早期组成部分，随后会持续发展为剩余心肌的容量超负荷肥大。限制心肌坏死的治疗与保留更正常的心室结构相关。心室重构的晚期也已证明可通过治疗改善，因为长期使用血管紧张素转换酶（ACE）抑制剂与心室扩张程度的降低相关。目前，临床研究不仅对急性心肌梗死后进行ACE抑制治疗是否会保留心室容积和形态非常感兴趣，更重要的是，它是否会改善临床结局。
