Bellabarba G, Davila D F, Torres A, Donis J H, Gonzalez J C, Figueroa O, Vasquez C J, Faddoul M, Khoury A
Centro Cardiovascular, Universidad de Los Andes, Venezuela.
Int J Cardiol. 1994 Nov;47(1):5-11. doi: 10.1016/0167-5273(94)90127-9.
Chagasic patients with advanced heart disease have fluid retention-dependent symptoms. Since fluid retention is mostly dependent on the renin-angiotensin-aldosterone system, chagasic patients with congestion related symptoms should have activation of the renin-angiotensin-aldosterone system. The purpose of this investigation was to determine the plasma renin activity baseline values of chagasic patients with and without congestive heart failure. Twenty-eight patients with positive serology for Chagas' disease were studied. Nineteen patients were asymptomatic (functional class I New York Heart Association) and nine were symptomatic (functional classes II-IV). Cardiac catheterization and ventricular cineangiography were performed on 20 patients. The symptomatic patients had significantly higher plasma renin activity levels (4.11 +/- 1.03 ng/ml/h) than the asymptomatic patients (1.08 +/- 0.11 ng/ml/h, P < 0.001) and the normal sedentary controls (1.65 +/- 0.22 ng/ml/h, P < 0.05, mean +/- S.E.). The plasma renin activity baseline values of the asymptomatic and symptomatic patients correlated directly with the baseline heart rate (r = 0.77, P < 0.0001). The symptomatic patients had larger ventricular volumes, moderately depressed ejection fractions and increased left ventricular end-diastolic pressures. The plasma renin activity baseline values also correlated directly with the left ventricular diastolic pressures (r = 0.70, P < 0.0006) and with the left ventricular diastolic (r = 0.66, P < 0.001) and systolic volumes (r = 0.67, P < 0.001). These results indicate that chagasic patients with fluid retention-dependent symptoms and hemodynamic evidence of left ventricular systolic dysfunction have activation of the renin-angiotensin-aldosterone system.
患有晚期心脏病的恰加斯病患者有与液体潴留相关的症状。由于液体潴留大多依赖肾素-血管紧张素-醛固酮系统，有充血相关症状的恰加斯病患者应存在肾素-血管紧张素-醛固酮系统的激活。本研究的目的是确定有和没有充血性心力衰竭的恰加斯病患者的血浆肾素活性基线值。对28名恰加斯病血清学阳性的患者进行了研究。19名患者无症状（纽约心脏协会心功能I级），9名患者有症状（心功能II-IV级）。对20名患者进行了心导管检查和心室造影。有症状的患者血浆肾素活性水平（4.11±1.03 ng/ml/h）显著高于无症状患者（1.08±0.11 ng/ml/h，P<0.001）和正常久坐对照组（1.65±0.22 ng/ml/h，P<0.05，均值±标准误）。无症状和有症状患者的血浆肾素活性基线值与基线心率直接相关（r = 0.77，P<0.0001）。有症状的患者心室容积更大，射血分数中度降低，左心室舒张末压升高。血浆肾素活性基线值也与左心室舒张压直接相关（r = 0.70，P<0.0006），与左心室舒张末期容积（r = 0.66，P<0.001）和收缩末期容积（r = 0.67，P<0.001）直接相关。这些结果表明，有与液体潴留相关症状且有左心室收缩功能障碍血流动力学证据的恰加斯病患者存在肾素-血管紧张素-醛固酮系统的激活。
