心脏与循环血管紧张素转换酶抑制对肥厚性梗阻性心肌病左心室舒张功能和冠状动脉血流的影响。

Effects of cardiac versus circulatory angiotensin-converting enzyme inhibition on left ventricular diastolic function and coronary blood flow in hypertrophic obstructive cardiomyopathy.

作者信息

Kyriakidis M, Triposkiadis F, Dernellis J, Androulakis A E, Mellas P, Kelepeshis G A, Gialafos J E

机构信息

Department of Cardiology, Laiko Hospital of Athens, Greece.

出版信息

Circulation. 1998 Apr 14;97(14):1342-7. doi: 10.1161/01.cir.97.14.1342.

DOI:10.1161/01.cir.97.14.1342

PMID:9577944

Abstract

BACKGROUND

Left ventricular (LV) diastolic function and coronary flow are impaired in hypertrophic obstructive cardiomyopathy (HOCM). This study was designed to evaluate the impact of cardiac and circulatory ACE inhibition on such derangements.

METHODS AND RESULTS

Twenty patients with HOCM underwent cardiac ACE inhibition with intracoronary (IC) enalaprilat (0.05 mg/min infused into the left anterior descending coronary artery for 15 minutes) followed by circulatory ACE inhibition with 25 mg sublingual (SL) captopril. Contrast ventriculography, pressure, and coronary flow measurements were performed at baseline, after IC enalaprilat infusion, and 45 minutes after SL captopril. Heart rate was not affected by the respective interventions (75+/-11 versus 76+/-13 versus 75+/-10 bpm; P=NS), whereas mean aortic pressure dropped slightly after IC enalaprilat and significantly after SL captopril (90+/-8 versus 85+/-10 versus 74+/-9 mm Hg; P<.05). Compared with baseline, IC enalaprilat resulted in a decrease in LV end-diastolic pressure (17.6+/-5.9 versus 14.4+/-4.9 mm Hg; P<.05), time constant of isovolumic LV pressure relaxation (tauG) (69+/-9 versus 52+/-10 ms; P<.05), and outflow gradient (45.2+/-6.9 versus 24.4+/-3.7 mm Hg; P<.05) and in an increase in coronary blood flow (107+/-10 versus 127+/-12 mL/min; P<.05) and coronary flow reserve (2.2+/-0.4 versus 2.6+/-0.3; P<.05). After SL captopril, tauG was prolonged (60+/-13 ms; P<.05 versus IC enalaprilat), and LV outflow gradient, coronary blood flow, and coronary flow reserve values returned to baseline (45.5+/-5.3 mm Hg, 107+/-12 mL/min, and 2.2+/-0.5, respectively; P=NS versus baseline).

CONCLUSIONS

Activation of the cardiac renin-angiotensin system contributes to LV diastolic dysfunction as well as to the decreased coronary blood flow and coronary flow reserve in HOCM. Cardiac ACE inhibition restores and circulatory ACE inhibition aggravates the above derangements.

摘要

背景

肥厚性梗阻性心肌病（HOCM）患者存在左心室（LV）舒张功能和冠状动脉血流受损的情况。本研究旨在评估心脏和循环系统中血管紧张素转换酶（ACE）抑制对这些紊乱的影响。

方法与结果

20例HOCM患者先接受心脏ACE抑制，经冠状动脉内（IC）注入依那普利拉（以0.05 mg/min的速度注入左前降支冠状动脉15分钟），随后接受循环系统ACE抑制，舌下含服（SL）卡托普利25 mg。在基线、IC注入依那普利拉后以及SL含服卡托普利45分钟后进行对比心室造影、压力和冠状动脉血流测量。心率不受相应干预措施的影响（分别为75±11次/分钟、76±13次/分钟、75±10次/分钟；P=无显著性差异），而平均主动脉压在IC注入依那普利拉后略有下降，在SL含服卡托普利后显著下降（分别为90±8 mmHg、85±10 mmHg、74±9 mmHg；P<0.05）。与基线相比，IC注入依那普利拉导致左心室舒张末期压力降低（17.6±5.9 mmHg对14.4±4.9 mmHg；P<0.05）、左心室等容压力松弛时间常数（tauG）降低（69±9毫秒对52±10毫秒；P<0.05）、流出道梯度降低（45.2±6.9 mmHg对24.4±3.7 mmHg；P<0.05），冠状动脉血流增加（107±10 mL/min对127±12 mL/min；P<0.05）以及冠状动脉血流储备增加（2.2±0.4对2.6±0.3；P<0.05）。SL含服卡托普利后，tauG延长（60±13毫秒；与IC注入依那普利拉相比P<0.05），左心室流出道梯度、冠状动脉血流和冠状动脉血流储备值恢复至基线水平（分别为45.5±5.3 mmHg、107±12 mL/min、2.2±0.5；与基线相比P=无显著性差异）。