血管紧张素转换酶抑制剂减轻暴发性心肌炎后慢性持续性心脏功能障碍的发生：一项中国多中心回顾性研究
Angiotensin-Converting Enzyme Inhibitors Mitigate Development of Chronic Persistent Cardiac Dysfunction Following Fulminant Myocarditis: A Multicenter Retrospective Study in China.
作者信息
Yang Hong, Qidamugai Wuyun, Wang Luyun, Liu FuYang, He Yi, Xu Zheng, Zhang Li, Li Fan, Wang Hong, Jiang Jiangang
机构信息
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, People's Republic of China.
出版信息
Int J Gen Med. 2025 Sep 9;18:5267-5281. doi: 10.2147/IJGM.S543878. eCollection 2025.
BACKGROUND
Although temporary mechanical circulatory supports (tMCS) combined with immunoregulatory therapy (IT) can reduce the mortality of patients with fulminant myocarditis (FM), a considerable proportion still progress to chronic persistent cardiac dysfunction. It is unclear if angiotensin-converting enzyme (ACE) inhibitors can further prevent such dysfunction under tMCS combined with IT.
METHODS
This multicenter, retrospective, observational study included 124 FM patients with a left ventricular ejection fraction (LVEF) ≤ 40%. Among them, 90 (72.58%) received ACE inhibitors and 34 (27.42%) did not. Patients had echocardiography during follow-up. Logistic regression analysis, subgroup analysis, and restricted cubic spline modeling were used to identify clinical variables associated with the primary outcome.
RESULTS
The primary outcome was defined as an LVEF < 55% at the last follow-up. The median follow-up was 12 (6, 18) months. 46 patients (37.1%) had an LVEF < 55% at the last follow-up. Among them, 25 (27.78%) received ACE inhibitors and 21 (61.76%) did not. In the non-ACE inhibitors group, LVEF declined from baseline over 24 months. Among the 49 patients (39.52%) with a left ventricular end-diastolic dimension (LVEDD) ≥ 5cm at admission, 29 (59.18%) had an LVEF < 55% at the last follow-up. 15 patients (51.72%) took ACE inhibitors and 14 (48.28%) did not. Multivariate logistic regression analysis revealed that ACE inhibitors (HR = 0.19, 95% CI: 0.04-0.96, P = 0.045) and LVEDD (HR = 9.18, 95% CI: 2.73-30.83, P < 0.001) were independently associated with an LVEF < 55% at the last follow-up, and the risk increased linearly with LVEDD (P for nonlinear > 0.05).
CONCLUSION
ACE inhibitors may improve left ventricular (LV) function and prevent chronic persistent cardiac dysfunction in FM patients. Although they can partially reverse LV remodeling, increased LVEDD during long-term follow-up may reduce their therapeutic benefits.
背景
尽管临时机械循环支持（tMCS）联合免疫调节治疗（IT）可降低暴发性心肌炎（FM）患者的死亡率，但仍有相当一部分患者进展为慢性持续性心脏功能障碍。尚不清楚血管紧张素转换酶（ACE）抑制剂在tMCS联合IT治疗下能否进一步预防此类功能障碍。
方法
这项多中心、回顾性、观察性研究纳入了124例左心室射血分数（LVEF）≤40%的FM患者。其中，90例（72.58%）接受了ACE抑制剂治疗，34例（27.42%）未接受。患者在随访期间进行了超声心动图检查。采用逻辑回归分析、亚组分析和受限立方样条模型来确定与主要结局相关的临床变量。
结果
主要结局定义为最后一次随访时LVEF<55%。中位随访时间为12（6，18）个月。46例患者（37.1%）在最后一次随访时LVEF<55%。其中，25例（27.78%）接受了ACE抑制剂治疗，21例（61.76%）未接受。在未使用ACE抑制剂组中，LVEF在24个月内从基线水平下降。在入院时左心室舒张末期内径（LVEDD）≥5cm的49例患者（39.52%）中，29例（59.18%）在最后一次随访时LVEF<55%。15例患者（51.72%）服用了ACE抑制剂，14例（48.28%）未服用。多因素逻辑回归分析显示，ACE抑制剂（HR=0.19，95%CI：0.04-0.96，P=0.045）和LVEDD（HR=9.18，95%CI：2.73-30.83，P<0.001）与最后一次随访时LVEF<55%独立相关，且风险随LVEDD呈线性增加（非线性P>0.05）。
结论
ACE抑制剂可能改善FM患者的左心室（LV）功能并预防慢性持续性心脏功能障碍。尽管它们可部分逆转LV重塑，但长期随访期间LVEDD增加可能会降低其治疗效果。
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