Shimoyama H, Sabbah H N, Rosman H, Kono T, Alam M, Goldstein S
Department of Medicine, Henry Ford Heart and Vascular Institute, Detroit, Michigan.
J Am Coll Cardiol. 1995 Mar 1;25(3):768-72. doi: 10.1016/0735-1097(94)00426-Q.
This study examined the effects of early long-term monotherapy with enalapril on the severity of functional mitral regurgitation in dogs with moderate heart failure.
Functional mitral regurgitation often develops in patients with heart failure and, depending on its severity, can have a marked adverse impact on the stroke output of the failing left ventricle and contribute to progressive deterioration of the heart failure state.
Left ventricular dysfunction (ejection fraction 30% to 40%) was produced in 14 dogs by multiple sequential intracoronary microembolizations. Dogs were randomized to 3 months of therapy with enalapril (10 mg twice daily, n = 7) or no therapy at all (control, n = 7). The severity of functional mitral regurgitation was quantified by Doppler color flow mapping in seven control and six enalapril-treated dogs. Mitral annular diameter was assessed by echocardiography and left ventricular volumes and shape by ventriculography. Measurements were made before initiation and after completion of therapy.
In control dogs, the severity of mitral regurgitation increased during the follow-up period ([mean +/- SEM] 14 +/- 4 vs. 23 +/- 4%, p < 0.001) and was associated with increased left ventricular end-systolic and end-diastolic volumes. In contrast, the severity of regurgitation was not significantly changed in dogs treated with enalapril (18 +/- 3 vs. 16 +/- 6%, p < 0.59) and was associated with preservation of left ventricular volumes.
In dogs with moderate heart failure, early long-term therapy with enalapril prevents progressive worsening of functional mitral regurgitation. This beneficial effect is most likely achieved by prevention of progressive left ventricular dilation.
本研究探讨依那普利早期长期单一疗法对中度心力衰竭犬功能性二尖瓣反流严重程度的影响。
功能性二尖瓣反流常发生于心力衰竭患者，根据其严重程度，可对衰竭左心室的每搏输出量产生显著不利影响，并促使心力衰竭状态逐渐恶化。
通过多次序贯冠状动脉内微栓塞，使14只犬产生左心室功能障碍（射血分数30%至40%）。将犬随机分为两组，一组接受依那普利治疗3个月（10毫克，每日两次，n = 7），另一组不接受任何治疗（对照组，n = 7）。通过多普勒彩色血流图对7只对照犬和6只接受依那普利治疗的犬的功能性二尖瓣反流严重程度进行量化。通过超声心动图评估二尖瓣环直径，通过心室造影评估左心室容积和形状。在治疗开始前和结束后进行测量。
在对照犬中，二尖瓣反流的严重程度在随访期间增加（[平均值±标准误]14±4对23±4%，p < 0.001），并与左心室收缩末期和舒张末期容积增加相关。相比之下，接受依那普利治疗的犬反流严重程度无显著变化（18±3对16±6%，p < 0.59），且与左心室容积保持相关。
在中度心力衰竭犬中，依那普利早期长期治疗可预防功能性二尖瓣反流的逐渐恶化。这种有益作用很可能是通过预防左心室逐渐扩张实现的。
