Nordrehaug J E, Vollset S E
Medical Department, Haukeland Hospital, University of Bergen, Norway.
Am Heart J. 1993 Mar;125(3):771-6. doi: 10.1016/0002-8703(93)90169-a.
We studied 14 patients who had exercise-induced ventricular arrhythmias after a previous Q-wave myocardial infarction. All had symptomatic mild heart failure in New York Heart Association class II and a maximal oxygen consumption between 16 and 20 ml/kg/min. They were treated with the angiotensin converting enzyme inhibitor benazepril (20 mg) and hydrochlorothiazide (50 mg) for 3 months in a double-blind randomized cross-over study. Benazepril improved the maximal oxygen uptake by 15% and exercise time by 18%. Hydrochlorothiazide slightly increased exercise time (5%) and the respiratory exchange ratio but not oxygen consumption. The arrhythmias were nonsustained and reproducible in two baseline recordings. Compared with baseline, benazepril reduced the mean number (3.5 +/- 2.5) (+/- SD) of episodes of ventricular tachycardia by 66%, and total (47.4 +/- 40.9) and paired (5.2 +/- 4.5) premature ventricular contractions by 61% and 62%, respectively. Hydrochlorothiazide did not reduce the number of arrhythmias. Thus an improved cardiac function induced by benazepril is associated with a reduction in exercise-induced ventricular arrhythmias in patients with symptomatic mild heart failure after infarction.
我们研究了14例曾发生过Q波心肌梗死后出现运动诱发室性心律失常的患者。所有患者均有纽约心脏协会II级症状性轻度心力衰竭，最大耗氧量在16至20 ml/kg/min之间。在一项双盲随机交叉研究中，他们接受血管紧张素转换酶抑制剂贝那普利（20 mg）和氢氯噻嗪（50 mg）治疗3个月。贝那普利使最大摄氧量提高了15%，运动时间延长了18%。氢氯噻嗪使运动时间略有增加（5%），呼吸交换率升高，但耗氧量未增加。心律失常在两次基线记录中为非持续性且可重复出现。与基线相比，贝那普利使室性心动过速发作的平均次数（3.5±2.5）（±标准差）减少了66%，使室性早搏总数（47.4±40.9）和成对室性早搏（5.2±4.5）分别减少了61%和62%。氢氯噻嗪未减少心律失常的次数。因此，贝那普利诱导的心脏功能改善与心肌梗死后有症状轻度心力衰竭患者运动诱发的室性心律失常减少有关。
