缬沙坦对心肌梗死患者行冠状动脉介入治疗后心室重构的影响

Effect of valsartant on ventricular remodeling in patients with myocardial infarction after percutaneous coronary intervention

目的观察心肌梗死患者行冠状动脉介入治疗后,应用血管紧张素Ⅱ-1型受体拮抗剂缬沙坦对心室重构的影响。方法经皮冠状动脉介入治疗(PCI)58例,28例术后服用缬沙坦80mg/d;30例术后未服用缬沙坦及其他血管紧张素Ⅱ-1型受体拮抗剂或相关类药物。缬沙坦组和常规治疗组均于手术前3d内,手术后3个月和6个月行静息心肌灌注断层显像。结果2组在PCI治疗前及治疗后3个月左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)及左心室射血分数(LVEF)比较差异均无显著性,但6个月时缬沙坦组比常规治疗组LVEDV[(102.6±25.6)mLvs(117.2±28.5)mLP=0.045]及LVESV[(53.1±20.6)mLvs(66.4±28.7)mLP=0.049]明显减小,而LVEF明显增大[(56.1±9.6)%vs(47.4±13.2)%P=0.006]。随访13个月,缬沙坦组比常规治疗组临床事件发生率明显减少(24.0%vs46.7%P=0.04)。结论应用缬沙坦,可有效的防止心室重构,减少临床事件发生。

Objective： To observe impact of valsartant on ventricular remodeling for MI patients after PCI. Method：Chose 58 patients with myocardial infarction and treated with PCI therapy. 28 patients took valsartant （80 mg/d） after the operations, and the others not. Both groups took ^99 TC^mMIBI myocardial perfusion imaging test assessing left ventricular size and function at 3 days before 3 months and 6 months after the operations regarding left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left ventricular ejection fraction （LVEF）, etc, Clinical follow-up was obtained. Result： Before PCI therapy and during 3 months of follow-up after the therapy, there were not significant difference between the two groups in LVEDV, LVESV and LVEF. However, significant changes in LVEDV[ （ 102.6 ± 25.6）mL vs （ 117.2 ± 28.5）mL P = 0.045] and LVESV [ （53.1 ± 20.6）mL vs （66.4 ± 28.7）mL P = 0.049] were observed within the two groups at 6 months of the follow-up,and the LVEF of valsartant group increased dramatically than the normally treated group [ （56.1 ± 9.6）% vs （47.4 ± 13.2 ） % P = 0.006]. During a follow-up duration of 13 months, combined clinical events rate （myocardial infarction again, heart failure, angina pectoris, stroke, death, revascularization and so on）, favors a policy of valsartant group （24.0 % vs 46.7 % P = 0. 04）. Conclusion： Patients with myocardial infaction should take the specific antagonist of AT1 receptor valsartant on time just after percutaneous coronary intervention therapy. It can keep away from ventricular remodeling more efficiently and protect left ventricular function. Furthermore, it can promate patients＇ recovery and improve living rate.