Johnson D B, Foster R E, Barilla F, Blackwell G G, Roney M, Stanley A W, Kirk K, Orr R A, van der Geest R J, Reiber J H, Dell'Italia L J
Department of Medicine, Birmingham Veteran Affairs Medical Center, Alabama.
J Am Coll Cardiol. 1997 Jan;29(1):49-54. doi: 10.1016/s0735-1097(96)00451-2.
We tested the hypothesis that angiotensin-converting enzyme (ACE) inhibitor therapy decreases left ventricular (LV) mass in patients with a left ventricular ejection fraction (LVEF) > 40% and no evidence of heart failure after their first acute Q wave myocardial infarction (MI).
Recently, ACE inhibitor therapy has been shown to have an early mortality benefit in unselected patients with acute MI, including patients without heart failure and a LVEF > 35%. However, the effects on LV mass and volume in this patient population have not been studied.
Thirty-five patients with a LVEF > 40% after their first acute Q wave MI were randomized to titrated oral ramipril (n = 20) or conventional therapy (control, n = 15). Magnetic resonance imaging (MRI) performed an average of 7 days and 3 months after MI provided LV volumes and mass from summated serial short-axis slices.
Left ventricular end-diastolic volume index did not change in ramipril-treated patients (62 +/- 16 [SD] to 66 +/- 17 ml/m2) or in control patients (62 +/- 16 to 68 +/- 17 ml/m2), and stroke volume index increased significantly in both groups. However, LV mass index decreased in ramipril-treated patients (82 +/- 18 to 73 +/- 19 g/m2, p = 0.0002) but not in the control patients (77 +/- 15 to 79 +/- 23 g/m2). Systolic arterial pressure did not change in either group at 3-month follow-up.
In patients with a LVEF > 40% after acute MI, ramipril decreased LV mass, and blood pressure and LV function were unchanged after 3 months of therapy. Whether the decrease in mass represents a sustained effect that is associated with a decrease in morbid events requires further investigation.
我们检验了这样一个假设，即血管紧张素转换酶（ACE）抑制剂治疗可降低首次急性Q波心肌梗死（MI）后左心室射血分数（LVEF）>40%且无心力衰竭证据患者的左心室（LV）质量。
最近，ACE抑制剂治疗已被证明在未选择的急性MI患者中具有早期死亡率获益，包括无心力衰竭且LVEF>35%的患者。然而，该患者群体中对LV质量和容积的影响尚未得到研究。
35例首次急性Q波MI后LVEF>40%的患者被随机分为口服雷米普利滴定组（n = 20）或传统治疗组（对照组，n = 15）。在MI后平均7天和3个月进行的磁共振成像（MRI）从系列短轴切片总和中提供LV容积和质量。
雷米普利治疗的患者左心室舒张末期容积指数未改变（62±16[标准差]至66±17 ml/m²），对照组患者也未改变（62±16至68±17 ml/m²），两组的每搏输出量指数均显著增加。然而，雷米普利治疗的患者LV质量指数下降（82±18至73±19 g/m²，p = 0.0002），而对照组患者未下降（77±15至79±23 g/m²）。3个月随访时两组的收缩动脉压均未改变。
在急性MI后LVEF>40%的患者中，雷米普利降低了LV质量，治疗3个月后血压和LV功能未改变。质量的降低是否代表与不良事件减少相关的持续效应需要进一步研究。
