Erhardt L
Section of Cardiology, Malmö University Hospital, Sweden.
Eur J Clin Pharmacol. 1996;49 Suppl 1:S19-28.
Heart failure is a progressive disease and once the process has started it continues with further deterioration of cardiac function or ends in sudden death. In many patients changes within the heart start to develop long before clinical symptoms occur. The left ventricle goes through a number of adaptions-remodelling-to compensate for increased pressure or volume load or subsequent myocardial infarction. Several of these compensatory changes have prognostic implications and indicate increased risk of clinical heart failure or cardiac events. Thus, increased left ventricular dimensions, volume and mass together with reduced systolic function are all markers of poor prognosis. Treatment with angiotensin-converting enzyme (ACE) inhibitors before the onset of clinical heart failure has been shown to improve prognosis. Identification of individuals at high risk is difficult since signs and symptoms of heart failure are often lacking. A strategy to find these patients must use objective methods to characterise the state of the left ventricle. It is likely that not only patients with significant reduction of systolic function but also other signs of impaired left ventricular dysfunction will benefit from treatment with ACE inhibitors. Only by preventive treatment may we be able to decrease the number of patients with new onset of clinical heart failure.
心力衰竭是一种进行性疾病，一旦发病进程开始，心脏功能会持续进一步恶化，或最终导致猝死。在许多患者中，心脏内部的变化早在临床症状出现之前就开始发展。左心室会经历一系列适应性重塑，以代偿压力或容量负荷增加或随后的心肌梗死。其中一些代偿性变化具有预后意义，提示临床心力衰竭或心脏事件风险增加。因此，左心室尺寸、容积和质量增加以及收缩功能降低均是预后不良的标志。已证明在临床心力衰竭发作前使用血管紧张素转换酶（ACE）抑制剂进行治疗可改善预后。由于往往缺乏心力衰竭的体征和症状，识别高危个体很困难。寻找这些患者的策略必须采用客观方法来描述左心室状态。不仅收缩功能显著降低的患者，而且左心室功能受损的其他体征的患者，都可能从ACE抑制剂治疗中获益。只有通过预防性治疗，我们才有可能减少新发临床心力衰竭患者的数量。
