Bonarjee V V, Carstensen S, Caidahl K, Nilsen D W, Edner M, Lindvall K, Snapinn S M, Berning J
Cardiology Division, Department of Medicine, Central Hospital in Rogaland, Stavanger, Norway.
Am Heart J. 1996 Jul;132(1 Pt 1):71-7. doi: 10.1016/s0002-8703(96)90392-0.
Beta-blockers reduce infarct size and improve survival after acute myocardial infarction (MI). Post-MI angiotensin-converting enzyme inhibition also improves survival and may attenuate left ventricular (LV) dilatation. We evaluated the effect of early enalapril treatment on LV volumes and ejection fraction (EF) in patients on concomitant beta-blockade after MI. Intravenous enalaprilat or placebo was administered <24 hours after MI and was continued orally for 6 months. LV volumes were assessed by echocardiography 3 +/- 2 days, 1 and 6 months after MI. Change in LV diastolic volume during the first month was attenuated with enalapril (2.7 vs placebo 6.5 ml/m2 change; p < 0.05), and significantly lower LV diastolic and systolic volumes were observed with enalapril treatment compared with placebo at 1 month (enalapril 47.21 23.9 vs placebo 53.1/29.2 ml/m2; p < 0.05) and at 6 months (enalapril 47.9/24.8 vs placebo 53.8/29.6 ml/m2; p < 0.05). EF was also significantly higher 1 month after MI in these patients (enalapril 50.4% vs placebo 46.4%; p < 0.05). Our date demonstrate that early enalapril treatment attenuates LV volume expansion and maintains lower LV volumes and higher EF in patients receiving concurrent beta-blockade after MI. A possible additive effect of combined therapy should be evaluated prospectively.
β受体阻滞剂可缩小急性心肌梗死（MI）后的梗死面积并提高生存率。心肌梗死后使用血管紧张素转换酶抑制剂也可提高生存率，并可能减轻左心室（LV）扩张。我们评估了早期依那普利治疗对心肌梗死后同时使用β受体阻滞剂患者的左心室容积和射血分数（EF）的影响。在心肌梗死后<24小时给予静脉注射依那普利拉或安慰剂，并持续口服6个月。在心肌梗死后3±2天、1个月和6个月通过超声心动图评估左心室容积。依那普利可减轻第一个月左心室舒张末期容积的变化（变化值为2.7 vs安慰剂6.5 ml/m²；p<0.05），与安慰剂相比，依那普利治疗在1个月（依那普利47.2/23.9 vs安慰剂53.1/29.2 ml/m²；p<0.05）和6个月（依那普利47.9/24.8 vs安慰剂53.8/29.6 ml/m²；p<0.05）时观察到左心室舒张末期和收缩末期容积显著降低。这些患者在心肌梗死后1个月时的EF也显著更高（依那普利50.4% vs安慰剂46.4%；p<0.05）。我们的数据表明，早期依那普利治疗可减轻心肌梗死后同时接受β受体阻滞剂治疗患者的左心室容积扩大，并维持较低的左心室容积和较高的EF。联合治疗可能的附加作用应进行前瞻性评估。
