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首页> 外文期刊>Journal of the American College of Cardiology >Reduction of exercise-induced myocardial ischemia during add-on treatment with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade.
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Reduction of exercise-induced myocardial ischemia during add-on treatment with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade.

机译：左心功能正常且β受体阻滞剂正常的患者，在使用血管紧张素转换酶抑制剂依那普利追加治疗期间，可减少运动引起的心肌缺血。

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OBJECTIVES: We sought to study the effect of angiotensin-converting enzyme inhibition on exercise-induced myocardial ischemia. BACKGROUND: Although angiotensin-converting enzyme inhibitors have been shown to reduce ischemic events after myocardial infarction, few data are available regarding their direct anti-ischemic effects in patients with coronary artery disease. METHODS: We studied 43 patients (average age 63 +/- 8 years) with exercise-induced myocardial ischemia (> or =0.1 mV ST depression, despite optimal beta blockade) and normal left ventricular function (ejection fraction >0.50). In a double-blind, placebo-controlled parallel design, patients were treated with angiotensin-converting enzyme inhibitor (enalapril 10 mg twice daily) or placebo. Assessments were made after three weeks (short-term) and 12 weeks (long-term). RESULTS: At baseline, the groups were well matched for all clinical characteristics. After three weeks, there was a slight but not significant increase in time to 0.1 mV ST depression in both groups (p = NS); rate pressure product (RPP = heart rate x systolic blood pressure) was also unaffected. After 12 weeks, however, time to 0.1 mV ST depression further increased in the enalapril group (5.6 +/- 1.9 min) but was unchanged in the placebo group (4.4 +/- 1.3 min; p < 0.05 between groups). In contrast, RPP was not affected. Concentrations of both atrial and brain natriuretic peptides at peak exercise tended to be lower by enalapril, if compared to placebo (p = NS). CONCLUSIONS: Angiotensin-converting enzyme inhibition may reduce exercise-induced myocardial ischemia in patients with normal left ventricular function. Further studies are needed to elucidate the mechanisms involved.
机译：目的：我们试图研究血管紧张素转化酶抑制作用对运动性心肌缺血的影响。背景：尽管已显示血管紧张素转换酶抑制剂可减少心肌梗塞后的缺血事件，但有关其对冠心病患者的直接抗缺血作用的数据很少。方法：我们研究了43例运动诱发的心肌缺血（>或= 0.1 mV ST压抑，尽管有最佳的β阻滞）且左心室功能正常（射血分数> 0.50）的患者（平均年龄63 +/- 8岁）。在双盲，安慰剂对照的平行设计中，患者接受血管紧张素转换酶抑制剂（依那普利10 mg每天两次）或安慰剂治疗。在三周（短期）和12周（长期）之后进行评估。结果：在基线时，各组在所有临床特征上均匹配良好。三周后，两组的时间都略有增加，但均未达到0.1 mV ST下降（p = NS）;速率压力乘积（RPP =心率x收缩压）也不受影响。然而，在12周后，依那普利组（0.1 +/- 1.9分钟）到ST压低至0.1 mV ST的时间进一步增加，而在安慰剂组中则保持不变（4.4 +/- 1.3分钟;组间p <0.05）。相反，RPP不受影响。如果与安慰剂相比，依那普利会使高峰运动时心钠素和脑利钠肽的浓度降低（p = NS）。结论：血管紧张素转换酶抑制可减轻运动功能正常的左心室患者的心肌缺血。需要进一步研究以阐明涉及的机制。

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