Rodríguez J A, Godoy I, Castro P, Quintana J C, Chávez E, Yovanovich J, Corbalán R, Chávez A
Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile.
Rev Med Chil. 1997 Jun;125(6):643-52.
Studies have shown that angiotensin converting enzyme (ACE) inhibition prevents left ventricular remodeling and cardiovascular events after an acute myocardial infarction. The role of aldosterone in ventricular remodeling after a myocardial infarction has not been addressed.
To compare the effects of an ACE inhibitor, an aldosterone receptor antagonist and placebo on left ventricular remodeling after a first episode of transmural acute myocardial infarction.
Patients hospitalized for a first episode of acute myocardial infarction were blindly and randomly assigned to receive ramipril (2.5 mg bid), spironolactone (25 mg tid) or placebo. Ejection fraction, left ventricular end diastolic and end systolic volumes were measured by multigated radionuclide angiography, at baseline and after six months of treatment.
Twenty four patients were assigned to placebo, 31 to ramipril and 23 to spironolactone. Age, gender, Killip class, treatment with thrombolytics, revascularization procedures and use of additional medications were similar in the three groups. After six months of treatment, ejection fraction increased from 34.5 +/- 2.3 to 40.2 +/- 2.4% in patients on ramipril, from 32.6 +/- 2.9 to 36.6 +/- 2.7% in patients on spironolactone, and decreased from 37 +/- 3 to 31 +/- 3% in patients on placebo (ANOVA between groups p < 0.05). Basal end systolic volume was similar in all three groups, increased from 43.4 +/- 3.4 to 61.4 +/- 6.0 ml/m2 in patients on placebo and did not change in patients on spironolactone or ramipril (ANOVA p < 0.05). End diastolic volume was also similar in the three groups, increased from 70.6 +/- 4.3 to 92.8 +/- 6.4 ml/m2 in patients on placebo and did not change with the other treatments.
Ramipril and spironolactone had similar effects on ventricular remodeling after acute myocardial infarction, suggesting that aldosterone contributes to this phenomenon and that inhibition of its receptor may be as effective as ACE inhibition in its prevention.
研究表明，血管紧张素转换酶（ACE）抑制剂可预防急性心肌梗死后的左心室重构和心血管事件。醛固酮在心肌梗死后心室重构中的作用尚未得到探讨。
比较ACE抑制剂、醛固酮受体拮抗剂和安慰剂对首次透壁性急性心肌梗死后左心室重构的影响。
因首次急性心肌梗死住院的患者被随机、盲法分配接受雷米普利（2.5mg，每日两次）、螺内酯（25mg，每日三次）或安慰剂治疗。在基线和治疗6个月后，通过多门控放射性核素血管造影测量射血分数、左心室舒张末期和收缩末期容积。
24例患者被分配接受安慰剂治疗，31例接受雷米普利治疗，23例接受螺内酯治疗。三组患者的年龄、性别、Killip分级、溶栓治疗、血运重建手术及其他药物使用情况相似。治疗6个月后，雷米普利组患者的射血分数从34.5±2.3%增至40.2±2.4%，螺内酯组从32.6±2.9%增至36.6±2.7%，安慰剂组从37±3%降至31±3%（组间方差分析p<0.05）。三组患者的基础收缩末期容积相似，安慰剂组从43.4±3.4ml/m²增至61.4±6.0ml/m²，螺内酯组和雷米普利组患者无变化（方差分析p<0.05）。三组患者的舒张末期容积也相似，安慰剂组从70.6±4.3ml/m²增至92.8±6.4ml/m²，其他治疗组无变化。
雷米普利和螺内酯对急性心肌梗死后心室重构的作用相似，提示醛固酮参与了这一现象，且抑制其受体在预防方面可能与抑制ACE一样有效。
