VENTRICULAR UNLOADING AND IMPROVEMENT IN LEFT VENTRICULAR FUNCTION AFTER ANGIOTENSIN CONVERTING ENZYME INHIBITION WITH ENALAPRIL IN PATIENTS WITH CHRONIC CONGESTIVE HEART FAILURE

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概要

• 論文の詳細を見る

• To clarify how angiotensin converting enzyme inhibition affects left ventricular function through ventricular unloading, ventricular wall stress, ventricular volumes, and other cardiac indices and exercise tolerance were evaluated in 17 patients with mild to moderate chronic congestive heart failure before and after 3 months of treatment with enalapril. Echocardiographic examination revealed that treatment with this angiotensin converting enzyme inhibitor resulted in significant reductions in end-systolic wall stress (117±25 to 89±28 g/cm^2, p<0.01) and left ventricular volume indices (end-diastolic: 163±56 to 143±60; end-systolic 99±51 to 77±57 ml/m^2 p<0.01). Ejection fraction (42±11 to 48±13%, p<0.01) and systolic blood pressure/end-systolic volume (SBP/ESV; 1.06±0.30 to 1.33±0.48 mmHg/ml, p<0.01) were both increased. By radionuclide ventriculography, ejection fraction and peak ejection rate (2.30±0.74 to 2.80±0.76 EDV/sec, p<0.01) were increased, while time to peak ejection, time to peak filling, and peak filling rate were unchanged. Heart rate and double product at exercise were decreased and ΔEF was significantly increased (-1.4±4.1 to 1.6±4.4%, p<0.02). The decrease in end-systolic wall stress was consistently related to both the increase in ejection fraction and SBP/ESV, while the decrease in end-diastolic volume was related only to SBP/ESV and not to ejection fraction. Furthermore, there was a direct relationship between the decrease in systolic wall stress and the decrease in end-diastolic volume. These results suggest that the improvement of left ventricular contractility due to angiotensin converting enzyme inhibition was produced through a parallel reduction of both afterload and preload. Afterload reduction had a greater effect on the improvement of left ventricular ejection fraction than preload reduction.

• 社団法人日本循環器学会の論文
• 1993-12-20

著者

• Kubota Shouichi

  The Cardiovascular Center Yokosuka Kyousai Hospital

• Kumakura Hisao

  Second Department Of Internal Medicine Gunma University School Of Medicine

• Imai Susumu

  Second Department of Internal Medicine, Gunma University School of Medicine

• Suzuki Tadashi

  College of Medical Care and Technology, Gunma University School of Medicine

• Murata Kazuhiko

  Departments Of Diagnostic Radiology Gunma University School Of Medicine

• Kubota Sachio

  The Second Department Of Internal Medicine Gunma University School Of Medicine

• Iizuka Toshio

  Division Of Cardiology Fujioka General Hospital

• Imai Susumu

  Second Department Of Surgery Gunma University School Of Medicine

• Kamiyama Hiroshi

  Department Of Cardiology Isesaki Sawa Hospital

• NAGANUMA Fumio

  Second Department of Internal Medicine, Gunma University School of Medicine

• MURATA Kazuhiko

  Second Department of Internal Medicine, Gunma University School of Medicine

• KUBOTA Sachio

  Second Department of Internal Medicine,Gunma University School of Medicine

• Kanda Hiroshi

  The Second Department Of Internal Medicine Gunma University School Of Medicine

• Iizuka Toshio

  Second Department of Internal Medicine, Gunma University School of Medicine

• Kubota Shoichi

  Cardiology Divison Yokohama Rosai Hospital

• Murata Kazuhiko

  The 2nd Department Of Internal Medicine Gunma University Of Schoo L Of Medicine

• Imai Susumu

  Second Department Of Internal Medicine Gunma University School Of Medicine

• Imai Kunihiko

  The Second Department Of Internal Medicine Gunma University School Of Medicine

• Imai Kunihiko

  Second Department of internal medicine, Gunma University School of Medicine

• Kamiyama Hiroshi

  Second Department of internal medicine, Gunma University School of Medicine

• Kamiyama Hiroshi

  Kitakanto Cardiovascular Hospital

• Kanai Hiroyoshi

  Department Of Internal Medicine Cardiovascular Hospital Of Central Japan (kitakanto Cardiovascular H

• Ishikawa Susumu

  Second Department Of Surgery Gunma University School Of Medicine

• Suzuki Tadashi

  Fujioka General Hospital

• HIRAHARA NOBUTSUNE

  Second Department of Medicine, Gunma University School of Medicine

• Hirahara Nobutsune

  Second Department Of Medicine Gunma University School Of Medicine

• Iizuka Toshio

  The Second Department Of Internal Medicine Gunma University School Of Medicine

• Naganuma Fumio

  Division Of Cardiology Jushinkai Tsunoda Hospital

• Imai Kunihiko

  Second Department Of Internal Medicine Gunma University School Of Medicine

• Kusa Shigeki

  Department Of Cardiovascular Medicine Musashino Red Cross Hospital

• Murata Kazuhiko

  The Second Department Of Internal Medicine Gunma University School Of Medicine Maebashi

• Kubota Shuhei

  The Second Department Of Internal Medicine Gunma University School Of Medicine

• Murata Kazuhiko

  Second Department Of Internal Medicine Gunma University School Of Medicine

• Murata Kazuhiko

  The Second Department Of Internal Medicine Gunma University School Of Mledicine

• Murata Kazuhiko

  The Second Department Of Internal Medicine Gunma University School Of Medicine Maebashi Japan

• Mori Kazuo

  2nd Dept. Of Intern. Med. School Of Med. Gunma Univ.

• Suzuki Tadashi

  College Of Medical Care And Technology Gunma University School Of Medicine

• Kamiyama Hiroshi

  Division Of Cardiology Isesaki-sawa Medical Association Hospital

• MURATA Kazuhiko

  Second Department of Internal Medicine and the First Department of Pathology, Gunma University School of Medicine

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