Jugdutt B I
Department of Medicine, University of Alberta, Edmonton, Canada.
J Am Coll Cardiol. 1995 Jun;25(7):1718-25. doi: 10.1016/0735-1097(95)00040-b.
This study compared the effects of captopril and enalapril on left ventricular geometry, function and mass and on scar collagen and topography during healing after anterior and inferior myocardial infarction in a canine model.
The beneficial effect of prolonged angiotensin-converting enzyme inhibitor therapy on remodeling during healing after myocardial infarction might be greater in anterior than inferior infarcts and more effective with captopril than enalapril therapy.
The effects of 6 weeks of therapy with captopril (50 mg twice a day), enalapril (2.5 mg twice a day) or placebo on in vivo variables of left ventricular remodeling, function and mass (by echocardiography), hemodynamic function, postmortem topography (by planimetry) and collagen (hydroxyproline levels) were studied in 36 instrumented dogs randomized to receive therapy 48 h after left anterior descending or left circumflex coronary artery occlusion.
Compared with placebo therapy, both captopril and enalapril decreased infarct expansion and thinning, progressive ventricular dilation, ventricular mass and asynergy and infarct collagen levels in anterior and inferior infarcts. Despite similar small scar sizes, the effects on remodeling and dysfunction were greater in anterior than inferior infarcts. In addition, captopril produced greater attenuation of infarct expansion and ventricular enlargement, greater improvement in volume ejection fraction and less decrease in infarct collagen levels than enalapril.
On balance, captopril and enalapril attenuated left ventricular remodeling and preserved function in small anterior and inferior infarcts despite differences in the effects of the drugs on individual remodeling variables. Further studies will be needed to determine whether inhibition of infarct collagen might be harmful, or differences between captopril and enalapril therapy important, in large transmural infarctions.
本研究在犬模型中比较了卡托普利和依那普利对前壁和下壁心肌梗死后愈合过程中左心室几何形态、功能和质量以及瘢痕胶原和形态的影响。
心肌梗死后愈合过程中，长期使用血管紧张素转换酶抑制剂治疗对重塑的有益作用在前壁梗死中可能比下壁梗死更大，且卡托普利治疗比依那普利治疗更有效。
在36只植入仪器的犬中，研究了卡托普利（50毫克，每日两次）、依那普利（2.5毫克，每日两次）或安慰剂治疗6周对左心室重塑、功能和质量（通过超声心动图）、血流动力学功能、死后形态（通过平面测量）和胶原（羟脯氨酸水平）的体内变量的影响。这些犬在左前降支或左旋支冠状动脉闭塞后48小时随机接受治疗。
与安慰剂治疗相比，卡托普利和依那普利均减少了前壁和下壁梗死的梗死扩展和变薄、进行性心室扩张、心室质量和运动不协调以及梗死胶原水平。尽管瘢痕大小相似，但对重塑和功能障碍的影响在前壁梗死中比下壁梗死更大。此外，与依那普利相比，卡托普利对梗死扩展和心室扩大的减轻作用更大，对容积射血分数的改善更大，梗死胶原水平的降低更少。
总体而言，尽管这两种药物对个体重塑变量的影响存在差异，但卡托普利和依那普利在小面积前壁和下壁梗死中减轻了左心室重塑并保留了功能。需要进一步研究以确定在大面积透壁梗死中，抑制梗死胶原是否可能有害，或卡托普利和依那普利治疗之间的差异是否重要。
