Demirel Seref, Erk Osman, Unal Mehmet, Vatansever Sezai, Oflaz Hüseyin, Yücesir Ilker, Florinalı Nursal, Adalet Kamil
Department of Internal Medicine, University of Istanbul, Istanbul, Turkey.
Department of Sports Medicine, University of Istanbul, Istanbul, Turkey.
Curr Ther Res Clin Exp. 2003 Mar;64(3):167-75. doi: 10.1016/S0011-393X(03)00026-2.
Although angiotensin-converting enzyme inhibitors (ACEIs) have been shown to prolong life in patients with congestive heart failure (CHF), the prognosis of these patients remains poor.
The purpose of the study was to reevaluate a cohort of patients with CHF after 7 years of follow-up with cilazapril therapy to assess the renin-angiotensin system (RAS), anatomic and functional capacity of the heart, and aldosterone escape.
Surviving patients from a cohort hospitalized for CHF between January 1994 and December 1994 who were treated with cilazapril in our center were included in this study. Exercise testing was carried out using the Kattus protocol, and breath-by-breath oxygen analysis, echocardiography, and hormonal analysis were done.
Seven patients (5 men, 2 women; mean [SD] age, 70.6 [4.4]) were included in the study. Compared with the early effects (at 15 days) of cilazapril therapy, only mean (SD) peak exercise time decreased significantly at the 7-year follow-up (8.9 [2.4] minutes vs 5.1 [1.9] minutes; P = 0.02). Mean (SD) anaerobic threshold (AT) oxygen consumption and AT ratio increased slightly from 15 days, although these changes were not statistically significant (12.86 [3.5] mL/kg·min vs 13.57 [2.6] mL/kg·min; 70.3% [7.7%] vs 78.9% [9.8%], respectively). Compared with the early effect of therapy, patients had slightly lower mean (SD) ejection fractions (EFs), but the decrease did not reach statistical significance (52% [4%] vs 48% [4%]). Aldosterone levels were within normal limits in all patients, and 2 patients had increased RAS activity.
In this study, the observed lack of aldosterone escape, as well as patient survival during ACEI therapy, may be due to selection bias of the surviving patients, who had better EFs and lack of aldosterone escape. Therefore, the remaining issue seems to be the selection of patients who will not show aldosterone escape during chronic ACEI treatment.
尽管血管紧张素转换酶抑制剂（ACEI）已被证明可延长充血性心力衰竭（CHF）患者的寿命，但这些患者的预后仍然很差。
本研究的目的是在对接受西拉普利治疗7年的CHF患者队列进行重新评估，以评估肾素-血管紧张素系统（RAS）、心脏的解剖和功能能力以及醛固酮逃逸情况。
本研究纳入了1994年1月至1994年12月期间在我们中心因CHF住院并接受西拉普利治疗的队列中的存活患者。使用卡图斯方案进行运动测试，并进行逐次呼吸氧气分析、超声心动图检查和激素分析。
7名患者（5名男性，2名女性；平均[标准差]年龄，70.6[4.4]岁）被纳入研究。与西拉普利治疗的早期效果（15天时）相比，在7年随访时，仅平均（标准差）运动峰值时间显著缩短（8.9[2.4]分钟对5.1[1.9]分钟；P = 0.02）。平均（标准差）无氧阈值（AT）耗氧量和AT比值自15天起略有增加，尽管这些变化无统计学意义（分别为12.86[3.5]mL/kg·min对13.57[2.6]mL/kg·min；70.3%[7.7%]对78.9%[9.8%]）。与治疗早期效果相比，患者的平均（标准差）射血分数（EF）略低，但降低未达到统计学意义（52%[4%]对48%[4%]）。所有患者的醛固酮水平均在正常范围内，2名患者的RAS活性增加。
在本研究中，观察到的醛固酮逃逸缺失以及ACEI治疗期间患者的存活情况，可能归因于存活患者的选择偏倚，这些患者具有较好的EF且无醛固酮逃逸。因此，剩下的问题似乎是选择在慢性ACEI治疗期间不会出现醛固酮逃逸的患者。
