Ramirez-Gil J F, Drobinski G, Carayon A, Isnard R, Hoffman O, Sotirov I, Chanton E, Montalescot G, Thomas D
Service de cardiologie, CHU Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1993 Jul;86(7):1001-7.
The authors studied the responses of the main systems of sympathetic and hormonal regulation in valvular aortic stenosis, a special model of dissociation between arterial pressure and left ventricular function. The series comprised 14 patients with an average age of 70 +/- 9 years without diuretic therapy presenting with pure calcific aortic stenosis without other valvular or coronary disease. All were in sinus rhythm; 5 were taking an angiotensin converting enzyme inhibitor. Plasma concentrations of endothelin 1, atrial natriuretic factor (ANF), arginine vasopressin (AVP), catecholamines, plasma renin activity (PRA), angiotensin II and aldosterone were measured in resting, fasting patients, by blood samplings from a peripheral vein immediately before cardiac catheterisation. The results were compared with the severity of the aortic stenosis (aortic valve area greater or less than 0.7 cm2), the ratio of left ventricular work/myocardial mass (greater or less than 0.6) and treatment (with or without ACE inhibitors). Catecholamine levels were much higher in severe aortic stenosis (noradrenaline: 579 +/- 66 pg/ml when valve surface area > 0.7 cm2 versus 900 +/- 92 pg/ml when valve surface area < 0.7 cm2; p < 0.01). Endothelin -1 and AVP concentrations were normal. Whereas PRA was normal, aldosterone levels were increased in patients without treatment by ACE inhibitors. This treatment did not, however, normalise the noradrenaline levels. The increase in ANF concentration was large when left ventricular work decreased with respect to myocardial mass (190.8 +/- 42.3 pg/ml if W/M was decreased versus 82.7 +/- 15.4 pg/ml when W/M was normal): this could be related to the degree of left ventricular hypertrophy.
作者研究了主动脉瓣狭窄（一种动脉压与左心室功能分离的特殊模型）中交感神经和激素调节主要系统的反应。该系列包括14例平均年龄为70±9岁的患者，未接受利尿剂治疗，患有单纯钙化性主动脉瓣狭窄，无其他瓣膜或冠状动脉疾病。所有患者均为窦性心律；5例正在服用血管紧张素转换酶抑制剂。在静息、禁食的患者中，于心脏导管插入术前立即从外周静脉采血，测量血浆内皮素-1、心房利钠因子（ANF）、精氨酸加压素（AVP）、儿茶酚胺、血浆肾素活性（PRA）、血管紧张素II和醛固酮的浓度。将结果与主动脉瓣狭窄的严重程度（主动脉瓣面积大于或小于0.7 cm²）、左心室作功/心肌质量比（大于或小于0.6）以及治疗情况（使用或未使用ACE抑制剂）进行比较。重度主动脉瓣狭窄时儿茶酚胺水平明显更高（去甲肾上腺素：瓣膜表面积>0.7 cm²时为579±66 pg/ml，瓣膜表面积<0.7 cm²时为900±92 pg/ml；p<0.01）。内皮素-1和AVP浓度正常。虽然PRA正常，但未接受ACE抑制剂治疗的患者醛固酮水平升高。然而，这种治疗并未使去甲肾上腺素水平恢复正常。当左心室作功相对于心肌质量下降时，ANF浓度大幅升高（如果W/M降低，为190.8±42.3 pg/ml，而W/M正常时为82.7±15.4 pg/ml）：这可能与左心室肥厚程度有关。
