Lin M, Chiang H T, Lin S L, Chang M S, Chiang B N, Kuo H W, Cheitlin M D
Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, Republic of China.
J Am Coll Cardiol. 1994 Oct;24(4):1046-53. doi: 10.1016/0735-1097(94)90868-0.
This study attempted to evaluate the long-term efficacy of enalapril versus hydralazine therapy on left ventricular volume, mass and function as well as on the renin-angiotensin system in chronic asymptomatic aortic regurgitation.
We tested the hypothesis that early administration of a vasodilator drug might be able to reduce left ventricular dilation and mass expansion. Because the renin-angiotensin system may be activated in chronic aortic regurgitation, early enalapril therapy might be beneficial.
Between 1990 and 1993, 76 asymptomatic nonrheumatic patients with mild to severe chronic aortic regurgitation were enrolled in a randomized, double-blind trial comparing enalapril with hydralazine. All patients underwent serial noninvasive studies. Seventy patients completed the 12-month follow-up.
At 1 year, patients receiving enalapril had a significant reduction in left ventricular end-diastolic and end-systolic volume indexes (124 +/- 15 vs. 108 +/- 17 ml/m2, p < 0.01; 50 +/- 12 vs. 40 +/- 14 ml/m2, p < 0.01, respectively) and mass index (131 +/- 16 vs. 113 +/- 19 g/m2, p < 0.01), whereas hydralazine therapy showed no significant changes. Both regimens not only had a significant reduction in left ventricular mean wall stress but also had a mild increase in exercise duration. Only enalapril therapy achieved a significant inhibition of the renin-angiotensin system, in contrast to hydralazine therapy. Moreover, the multiple r2 value from the analysis for end-diastolic volume index using the two variables of age and treatment drugs was 72.1% (p < 0.01).
Both regimens decrease left ventricular mean wall stress. Enalapril therapy achieves significant left ventricular mass regression, left ventricular end-diastolic and end-systolic volume index reduction and renin-angiotensin system suppression. These findings suggest that early unloading enalapril therapy has the potential to favorably influence the natural history of chronic aortic regurgitation.
本研究试图评估依那普利与肼屈嗪治疗对慢性无症状性主动脉瓣关闭不全患者左心室容积、质量和功能以及肾素-血管紧张素系统的长期疗效。
我们检验了这样一个假设，即早期给予血管扩张剂药物或许能够减少左心室扩张和质量增加。由于肾素-血管紧张素系统可能在慢性主动脉瓣关闭不全中被激活，早期使用依那普利治疗可能有益。
在1990年至1993年期间，76例轻至重度慢性主动脉瓣关闭不全的无症状非风湿性患者被纳入一项比较依那普利与肼屈嗪的随机双盲试验。所有患者均接受了系列无创检查。70例患者完成了12个月的随访。
1年后，接受依那普利治疗的患者左心室舒张末期和收缩末期容积指数显著降低（分别为124±15与108±17ml/m²，p<0.01；50±12与40±14ml/m²，p<0.01）以及质量指数降低（131±16与113±19g/m²，p<0.01），而肼屈嗪治疗则无显著变化。两种治疗方案不仅使左心室平均壁应力显著降低，而且运动持续时间略有增加。与肼屈嗪治疗相比，只有依那普利治疗显著抑制了肾素-血管紧张素系统。此外，使用年龄和治疗药物这两个变量对舒张末期容积指数进行分析得到的复相关系数r²值为72.1%（p<0.01）。
两种治疗方案均降低左心室平均壁应力。依那普利治疗可使左心室质量显著减轻，左心室舒张末期和收缩末期容积指数降低，并抑制肾素-血管紧张素系统。这些发现表明，早期减轻负荷的依那普利治疗有可能对慢性主动脉瓣关闭不全的自然病程产生有利影响。
