左心室功能不全患者舒张功能的局部重塑和非均匀性改变：长期依那普利治疗的影响。SOLVD研究人员。

Regional remodeling and nonuniform changes in diastolic function in patients with left ventricular dysfunction: modification by long-term enalapril treatment. The SOLVD Investigators.

作者信息

Hayashida W, Van Eyll C, Rousseau M F, Pouleur H

机构信息

University of Louvain, School of Medicine, Department of Physiology, Brussels, Belgium.

出版信息

J Am Coll Cardiol. 1993 Nov 1;22(5):1403-10. doi: 10.1016/0735-1097(93)90550-k.

DOI:10.1016/0735-1097(93)90550-k

PMID:8227798

Abstract

OBJECTIVES

The purpose of the present study was to assess the process of late regional remodeling and the changes in regional diastolic function at the base and apex of the left ventricle in patients with chronic systolic dysfunction.

BACKGROUND

Remodeling has been suggested to play an important role in the progression of left ventricular dysfunction and heart failure. However, the regional difference in the process of late remodeling and its relation to diastolic function remain unclear.

METHODS

In 32 patients with previous myocardial infarction and left ventricular ejection fraction < or = 35%, left ventricular hemodynamic and angiographic data were studied before and 1 year after randomization to conventional therapy with placebo (n = 12) or enalapril, 10 mg twice daily (n = 20). Left ventricular regional wall dynamics were analyzed in the basal and apical regions by the area method.

RESULTS

In the placebo group, left ventricular end-diastolic and end-systolic regional areas increased significantly over time at the base but were unchanged at the apex. At the base, the diastolic left ventricular pressure-regional area relation shifted rightward and the regional stiffness constant decreased (6.9 +/- 4.3 to 5.0 +/- 3.1 x 10(-3) mm-2, p < 0.05), indicating an increase in regional distensibility. At the apex, however, the diastolic pressure-regional area relation shifted upward slightly, and the regional stiffness constant increased from 11.5 +/- 4.4 to 14.4 +/- 5.6 x 10(-3) mm-2 (p = 0.08). The regional peak filling rate was maintained at the base but decreased at the apex (1,014 +/- 436 to 762 +/- 306 mm2/s, p < 0.05); further, the changes in regional peak filling rate during follow-up were inversely related to the changes in the regional stiffness constant (r = -0.78, p < 0.001) at the apex. In contrast, in the enalapril group, end-diastolic and end-systolic regional areas significantly decreased over time both at the base and at the apex. Diastolic pressure-regional area relations shifted leftward, but the regional stiffness constant and regional peak filling rate did not change significantly either at the base or at the apex.

CONCLUSIONS

These findings suggest that in patients with severe systolic left ventricular dysfunction, there was a regional difference in the process of late remodeling between the base and apex of the left ventricle, which was associated with nonuniform changes in regional diastolic function in the placebo group. The data also suggest that the nonuniform progression of regional remodeling and diastolic dysfunction was prevented by long-term enalapril treatment.

摘要

目的

本研究旨在评估慢性收缩功能障碍患者左心室底部和心尖部晚期局部重构过程以及局部舒张功能的变化。

背景

已有研究表明重构在左心室功能障碍和心力衰竭的进展中起重要作用。然而，晚期重构过程中的局部差异及其与舒张功能的关系仍不清楚。

方法

对32例既往有心肌梗死且左心室射血分数≤35%的患者，在随机接受安慰剂常规治疗（n = 12）或依那普利（每日2次，每次10 mg，n = 20）之前及之后1年，研究其左心室血流动力学和血管造影数据。采用面积法分析左心室底部和心尖部的局部室壁动力学。

结果

在安慰剂组，左心室舒张末期和收缩末期局部面积随时间在底部显著增加，但在心尖部无变化。在底部，舒张期左心室压力 - 局部面积关系向右移位，局部僵硬度常数降低（从6.9±4.3降至5.0±3.1×10⁻³ mm⁻²，p < 0.05），表明局部扩张性增加。然而，在心尖部，舒张期压力 - 局部面积关系略有向上移位，局部僵硬度常数从11.5±4.4增加至14.4±5.6×10⁻³ mm⁻²（p = 0.08）。局部峰值充盈率在底部维持不变，但在心尖部降低（从1,014±436降至762±306 mm²/s，p < 0.05）；此外，随访期间局部峰值充盈率的变化与心尖部局部僵硬度常数的变化呈负相关（r = -0.78，p < 0.001）。相比之下，在依那普利组，舒张末期和收缩末期局部面积在底部和心尖部均随时间显著减小。舒张期压力 - 局部面积关系向左移位，但底部和心尖部的局部僵硬度常数和局部峰值充盈率均无显著变化。