Pfeffer M A, Pfeffer J M
Circulation. 1987 May;75(5 Pt 2):IV93-7.
Increased ventricular volume is one of the most powerful predictors of reduced survival in patients with heart disease. Despite its well-documented prognostic significance, the magnitude of the progression of ventricular dilatation from the acute to the chronic phase of myocardial infarction has only recently been appreciated. In an experimental preparation of myocardial infarction in rats, left ventricular cavitary volume increased progressively even after histologic resolution of the infarct region. We hypothesized that this remodeling of the infarcted left ventricle was a response to an increase in both systolic and diastolic wall stresses and that captopril, by reducing wall stress, would attenuate the process. For comparably sized infarcts, the captopril-treated rats had smaller ventricular volumes at common distending pressures, yet they had maintained or improved cardiac output. Most importantly, long-term captopril therapy also prolonged the survival of these rats with experimental myocardial infarction. The implication of these animal studies is that the potential exists for the attenuation of progressive ventricular enlargement and improvement of survival of patients recovering from a myocardial infarction. At the present time, no information is available in patients as to the therapeutic potential of interrupting this insidious process of ventricular dilatation in order to improve survival. Clinical trials are required to determine whether salutary benefits similar to those observed in animals can be provided to patients recovering from a myocardial infarction.
心室容量增加是心脏病患者生存率降低的最强有力预测因素之一。尽管其预后意义已得到充分证明，但直到最近人们才认识到从心肌梗死急性期到慢性期心室扩张进展的程度。在大鼠心肌梗死的实验模型中，即使梗死区域在组织学上已愈合，左心室腔容量仍在逐渐增加。我们推测，梗死左心室的这种重塑是对收缩期和舒张期壁应力增加的一种反应，而卡托普利通过降低壁应力将减弱这一过程。对于大小相当的梗死灶，接受卡托普利治疗的大鼠在相同的扩张压力下心室容量较小，但它们维持或改善了心输出量。最重要的是，长期卡托普利治疗还延长了这些实验性心肌梗死大鼠的生存期。这些动物研究表明，有可能减轻进行性心室扩大，并改善心肌梗死后恢复患者的生存率。目前，关于中断这种隐匿性心室扩张过程以提高生存率的治疗潜力，在患者中尚无相关信息。需要进行临床试验来确定，能否为心肌梗死后恢复的患者提供与在动物中观察到的类似的有益效果。
