依贝沙坦和阿替洛尔可改善高血压伴左心室肥大患者的舒张功能

Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early(E) and peak of late(A) diastolic velocities(E/A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. Results: By similar reductions in blood pressure both groups progressively reduced the LV mass index, with a greater reduction in the irbesartan group(P=0.024). Diastolic function was improved similarly by irbesartan and atenolol; for example, the E/A ratio by 12 and 14%(P=0.022 and P< 0.001), and the pulmonary venous flow velocity by 10 and 7%(P=0.036 and P=0.001), respectively. The isovolumic relaxation time was improved by irbesartan(P=0.040) only, and was related to changes in LV geometry(P< 0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure(P=0.048). An improvement in diastolic function appeared greater in concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.

左室舒张功能是急性心肌梗死预后的一个独立标志吗?

In addition to clinical risk markers, indices of left ventricular(LV) systolic function are valuable prognostic markers after acute myocardial infarction(MI). Previous studies have also suggested that LV diastolic function may contribute with prognostic information. The present study assessed whether this assumption applies to a large population of patients with acute MI who underwent thrombolyt ic therapy.520 out of 608 patients participating in the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, with an ST-elevation acute MI underwe nt two-dimensional and Doppler echocardiographic examination at 4 (range 2-10) days after admission. During the follow-up period of 31 (S.D.±11) months, car diovascular death occurred in 57 (11%) patients, nonfatal acute MI occurred in 77 (15%), and 124 (24%) patients suffered a combined cardiovascular end-point (either nonfatal acute MI or cardiovascular death). Univariate regression analy sis showed that all indices of LV systolic function predicted cardiovascular dea th and combined cardiovascular end-points. Regarding LV diastolic function only a restrictive filling pattern predicted cardiovascular death. In a multistep mu ltivariate regression analysis in which the variables were introduced in a hiera rchic order age, history of systemic hypertension, wall motion score index (WMSi ), and history of previous MI and diabetes mellitus were independent predictors of cardiovascular death. A history of systemic hypertension or congestive heart failure were independent predictors of nonfatal acute MI, while a history of sys temic hypertension, wall motion score index and diabetes mellitus independently predicted combined cardiovascular end-points.The results of this study confirme d that clinical risk indicators and LV systolic function were the most important independent predictors of cardiovascular death and combined cardiovascular end -points. LV diastolic function assessed by Doppler-echocar-diography did not provide additional prognostic information.

心力衰竭患者再入院和心血管事件的预测

Aims: To analyse measures of clinical data, functional capacity, left ventricu lar function and neurohormonal activation for the ability to predict mortality a nd morbidity in patients after a hospitalisation for heart failure. Methods: In a prospective study, patients 60 years or above with systolic heart failure NYHA II-IV were followed for at least 18 months. At study start, a physical examina tion, echocardiography, blood samples and measurements of quality of life(QoL) b y Nottingham Health Profile were obtained. Data on mortality and readmission rat es were collected. Results: 208 patients, 58%men, with a mean age of 76 years, and an ejection fraction of 0.34 were included and followed for a mean of 1122 d ays. In all, 74(36%) patients died and 171(82%) were readmitted. By univariate analysis, readmissions were predicted by poor QoL(169±118 vs. 83±100, p< 0.00 1), age, creatinine, haemoglobin(p< 0.01 all) and diabetes(p< 0.1). By multivari ate analyses, QoL at study start was the only independent predictor of readmissi ons(χ2=25.2, p< 0.001). Mortality was univariately associated with QoL(183±117 vs. 142±115, p< 0.05) and in multivariate analyses to traditional variables: a ge, male gender, systolic function, BNP and serum creatinine(χ2=48.9, p< 0.001) . Conclusions: Measurements representing different aspects of the heart failure syndrome can easily be obtained to stratify long-term risks of mortality and mo rbidity in hospitalised heart failure patients. Poor QoL was a univariate predic tor for mortality and a strong multivariate predictor for the important outcome of readmission, pointing to the need for a simple assessment of QoL.