BACKGROUND:Recent clinical trials have suggested that therapy with angiotensin-converting enzyme inhibitors in asymptomatic patients with reduced left ventricular (LV) function can significantly reduce the incidence of congestive heart failure compared with patients receiving placebo. In the present study, we examined the effects of long-term monotherapy with enalapril, metoprolol, and digoxin on the progression of LV systolic dysfunction and LV chamber enlargement in dogs with reduced LV ejection fraction (EF). METHODS AND RESULTS:LV dysfunction was produced in 28 dogs by multiple sequential intracoronary microembolizations. Embolizations were discontinued when LVEF was 30% to 40%. Three weeks after the last embolization, dogs were randomized to 3 months of oral therapy with enalapril (10 mg twice daily, n = 7), metoprolol (25 mg twice daily, n = 7), digoxin (0.25 mg once daily, n = 7), or no treatment (control, n = 7). As expected, in untreated dogs, LVEF decreased (36 +/- 1% versus 26 +/- 1%, P < .001) and LV end-systolic volume (ESV) and end-diastolic volume (EDV) increased during the 3-month follow-up period (39 +/- 4 versus 57 +/- 6 mL, P < .001, and 61 +/- 6 versus 78 +/- 8 mL, P < .002, respectively). In dogs treated with enalapril or metoprolol, LVEF remained unchanged or increased after therapy compared with before therapy (35 +/- 1% versus 38 +/- 3% and 35 +/- 1% versus 40 +/- 3%, respectively, P < .05), whereas ESV and EDV remained essentially unchanged. In dogs treated with digoxin, EF remained unchanged but ESV and EDV increased significantly. CONCLUSIONS:In dogs with reduced LVEF, long-term therapy with enalapril or metoprolol prevents the progression of LV systolic dysfunction and LV chamber dilation. Therapy with digoxin maintains LV systolic function but does not prevent progressive LV enlargement.

译文

背景:最近的临床试验表明,与接受安慰剂的患者相比,对无症状的左心室(LV)功能降低的无症状患者进行血管紧张素转换酶抑制剂治疗可以显着降低充血性心力衰竭的发生率。在本研究中,我们检查了依那普利,美托洛尔和地高辛长期单药治疗对左室射血分数(EF)降低的犬左室收缩功能障碍和左室扩大的影响。
方法与结果:28例犬经多次冠状动脉内微栓塞术后产生LV功能障碍。当LVEF为30%至40%时,栓塞停止。最后一次栓塞后三周,将狗随机分为3个月口服依那普利(每天两次10毫克,n = 7),美托洛尔(每天两次25mg,n = 7),地高辛(0.25毫克每天一次,n = 7)口服治疗7)或不进行任何治疗(对照组,n = 7)。正如预期的那样,在未经治疗的狗中,LVEF在3个月内下降了(36 /-1%比26 /-1%,P <.001),LV收缩末期容积(ESV)和舒张末期容积(EDV)增加了随访期(分别为39 /-4对57 /-6 mL,P <.001和61 /-6对78 /-8 mL,P <.002)。在接受依那普利或美托洛尔治疗的狗中,与治疗前相比,LVEF在治疗后保持不变或升高(分别为35 /-1%对38 /-3%和35 /-1%对40 /-3%,P <.05 ),而ESV和EDV基本上保持不变。在用地高辛治疗的狗中,EF保持不变,但ESV和EDV显着增加。
结论:对于LVEF降低的犬,依那普利或美托洛尔的长期治疗可防止LV收缩功能障碍和LV腔扩张。地高辛的治疗可维持左心室收缩功能,但不能防止进行性左心室肥大。

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