Erdmann E
Klinik III für Innere Medizin, Universität zu Köln.
Z Kardiol. 1994;83 Suppl 4:75-9.
Chronic systolic heart failure after coronary heart disease or dilated cardiomyopathy is characterized by an increasing dilatation of the left ventricle and raised intracardial pressures. The higher the NYHA class, the higher are usually preload and afterload of the left ventricle. Concomitantly, the renin-angiotensin-aldosterone-system is stimulated, leading to neurohormonal activation of vasoconstrictive hormones. This will reduce the already depressed myocardial function even more. The addition of ACE-inhibitors to diuretics and digitalis has improved the prognosis of patients with severe and moderate heart failure. Thus, there is no question today that ACE-inhibitors are needed in chronic heart failure, irrespective of the origin. New investigations indicate that diuretics and digitalis are also needed in severe or moderate heart failure. They certainly lead to a decrease of symptoms. The significance of the local ACE-system seems to be greater than that of the circulating ACE-system, when chronic heart failure after myocardial infarction has to be treated. The prophylactic use of ACE-inhibitors after myocardial infarction with decreased ejection fraction will reduce the necessity of admittance to hospital and will also improve the prognosis.
冠心病或扩张型心肌病后的慢性收缩性心力衰竭的特征是左心室扩张加剧和心腔内压力升高。纽约心脏协会（NYHA）分级越高，左心室的前负荷和后负荷通常也越高。与此同时，肾素-血管紧张素-醛固酮系统被激活，导致血管收缩激素的神经激素激活。这将进一步降低本已受损的心肌功能。在利尿剂和洋地黄的基础上加用血管紧张素转换酶（ACE）抑制剂改善了重度和中度心力衰竭患者的预后。因此，如今毫无疑问，无论病因如何，慢性心力衰竭患者都需要使用ACE抑制剂。新的研究表明，重度或中度心力衰竭患者也需要利尿剂和洋地黄。它们肯定会减轻症状。在治疗心肌梗死后的慢性心力衰竭时，局部ACE系统的意义似乎大于循环ACE系统。心肌梗死后射血分数降低时预防性使用ACE抑制剂将减少住院的必要性，也将改善预后。
