Carson P, Johnson G, Fletcher R, Cohn J
Department of Cardiology, Veterans Affairs Medical Center, Washington, D.C. 20422, USA.
J Am Coll Cardiol. 1996 Mar 1;27(3):642-9. doi: 10.1016/0735-1097(95)00503-x.
This analysis sought to evaluate the clinical characteristics and outcome in heart failure with mild systolic dysfunction.
Although heart failure with mild systolic dysfunction occurs commonly, this is an understudied area because clinical trials have usually excluded patients with ejection fraction >35%.
The 422 patients with left ventricular ejection fraction </=35% were compared with 172 with a left ventricular ejection fraction >35% in the Vasodilator in Heart Failure Trial (V-HeFT I), whereas in V-HeFT-II 554 patients with a left ventricular ejection fraction </=35% were compared with 218 patients with a left ventricular ejection fraction >35% for mortality and clinical care. For a left ventricular ejection fraction >35%, treatment with hydralazine/isosorbide dinitrate was compared with prazosin and placebo therapy in V-HeFT I, and hydralazine/isosorbide dinitrate was compared with enalapril in V-HeFT II for mortality, clinical course and change in physiologic variables: ejection fraction, plasma norepinephrine levels, ventricular tachycardia and echocardiographic variables.
In both studies, patients with a left ventricular ejection fraction >35% differed principally in hypertensive history, higher functional capacity and radiographic and echocardiographic cardiac dimension from patients with a left ventricular ejection fraction </=35%, and plasma norepinephrine levels differed in V-HeFT II (p < 0.01). Patients with a left ventricular ejection fraction >35% had a lower cumulative mortality than those with a left ventricular ejection fraction </=35% (p < 0.0001) and less frequent hospital admissions for heart failure (p < 0.014, V-HeFT I; p < 0.005, V-HeFT II). Although cumulative mortality and morbidity did not differ between treatment groups in V-HeFT I, enalapril decreased overall mortality versus hydralazine/isosorbide dinitrate (p < 0.035) in V-HeFT II. For physiologic variables in V-HeFT II, enalapril decreased ventricular tachycardia at follow-up (p < 0.05).
In V-HeFT, heart failure with mild systolic dysfunction was associated with different characteristics and a more favorable prognosis than heart failure with more severe systolic dysfunction. Enalapril decreased overall mortality and sudden death compared with hydralazine/isosorbide dinitrate. Prospective trials are needed to address therapy for heart failure with mild systolic dysfunction.
本分析旨在评估轻度收缩功能障碍性心力衰竭的临床特征及预后。
尽管轻度收缩功能障碍性心力衰竭很常见，但这是一个研究不足的领域，因为临床试验通常排除射血分数>35%的患者。
在心力衰竭血管扩张剂试验（V-HeFT I）中，将422例左心室射血分数≤35%的患者与172例左心室射血分数>35%的患者进行比较；而在V-HeFT-II中，将554例左心室射血分数≤35%的患者与218例左心室射血分数>35%的患者进行死亡率及临床治疗方面的比较。对于左心室射血分数>35%的患者，在V-HeFT I中比较了肼屈嗪/硝酸异山梨酯与哌唑嗪及安慰剂治疗的效果，在V-HeFT II中比较了肼屈嗪/硝酸异山梨酯与依那普利在死亡率、临床病程及生理变量变化（射血分数、血浆去甲肾上腺素水平、室性心动过速及超声心动图变量）方面的差异。
在两项研究中，左心室射血分数>35%的患者与左心室射血分数≤35%的患者相比，主要在高血压病史、更高的功能能力以及影像学和超声心动图心脏大小方面存在差异，且在V-HeFT II中血浆去甲肾上腺素水平也有所不同（p<0.01）。左心室射血分数 >35%的患者累积死亡率低于左心室射血分数≤35%的患者（p<0.0001），因心力衰竭住院的频率也更低（V-HeFT I中p<0.014；V-HeFT II中p<0.005）。尽管在V-HeFT I中各治疗组之间累积死亡率和发病率无差异，但在V-HeFT II中依那普利与肼屈嗪/硝酸异山梨酯相比可降低总体死亡率（p<0.035）。对于V-HeFT II中的生理变量，依那普利在随访时可降低室性心动过速的发生率（p<0.05）。
在V-HeFT研究中，轻度收缩功能障碍性心力衰竭与重度收缩功能障碍性心力衰竭相比具有不同的特征和更有利的预后。与肼屈嗪/硝酸异山梨酯相比，依那普利可降低总体死亡率和猝死率。需要进行前瞻性试验来探讨轻度收缩功能障碍性心力衰竭的治疗方法。
