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【文摘发布】冠脉内依那普利预处理在经皮冠脉
Author：Massoud A. Leesar, MD, Hani Jneid, MD, Xian-Liang Tang, MD and Roberto Bolli, MD*
Division of Cardiology, University of Louisville, Louisville, Kentucky.
Objectives: We tested the hypothesis that enalaprilat induces preconditioning (PC)-mimetic actions in patients with stable coronary artery disease.
Background: Angiotensin-converting enzyme (ACE) inhibitors increase the bioavailability of bradykinin, which induces cardiac PC.
Methods: Twenty-two patients undergoing coronary angioplasty were randomized to an intracoronary infusion of enalaprilat or placebo, followed 10 min later by a PC protocol.
Results: In control patients, the ST-segment shift was greater during the first inflation than during the second and third inflations, both on the intracoronary electrocardiogram (ECG) (21.0 ± 2.8 mm vs. 13.0 ± 2.0 mm and 13.0 ± 2.0 mm, p < 0.05) and the surface ECG (16.0 ± 4.0 mm vs. 10.0 ± 2.0 mm and 9.0 ± 2.0 mm, p < 0.05). In contrast, enalaprilat-pretreated patients showed no change in ST-segment shift during inflations on either the intracoronary or the surface ECG. During the first inflation, the ST-segment shift was significantly smaller in treated versus control patients. The chest pain score during the first inflation was also significantly smaller in treated patients versus control patients (33.0 ± 6.0 mm vs. 64.0 ± 6.0 mm) and did not change in treated patients during the second and third inflations, whereas it decreased significantly in control patients. In a subset of 6 patients, enalaprilat increased coronary blood flow during infusion, but this effect dissipated before the beginning of angioplasty.
Conclusions: Pretreatment with enalaprilat attenuates the manifestations of myocardial ischemia during angioplasty. This is the first in vivo evidence showing that an ACE inhibitor protects human myocardium, possibly via PC-mimetics actions, a novel property that might explain the cardioprotective actions of these drugs.
http://content.onlinejacc.org/cgi/content/abstract/49/15/1607?etoc
来源：J Am Coll Cardiol, 2007; 49:1607-1610
影响因子：9.0 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Title：Pretreatment With Intracoronary Enalaprilat Protects Human Myocardium During Percutaneous Coronary Angioplasty
标题：冠脉内依那普利预处理在经皮冠脉血管成形术时的心肌保护效应
Author：Massoud A. Leesar, MD, Hani Jneid, MD, Xian-Liang Tang, MD and Roberto Bolli, MD*
Division of Cardiology, University of Louisville, Louisville, Kentucky.
作者：Massoud A. Leesar, MD, Hani Jneid, MD, Xian-Liang Tang, MD and Roberto Bolli, MD
作者单位：肯塔基州路易斯维尔大学心脏病学系
Objectives: We tested the hypothesis that enalaprilat induces preconditioning (PC)-mimetic actions in patients with stable coronary artery disease.
目的：探讨在稳定型冠心病患者中给予依那普利是否具有拟预处理效应。
Background: Angiotensin-converting enzyme (ACE) inhibitors increase the bioavailability of bradykinin, which induces cardiac PC.
背景：血管紧张素抑制剂依那普利能够增加缓激肽的生物利用度，缓激肽具有心肌缺血预适应保护作用。
Methods: Twenty-two patients undergoing coronary angioplasty were randomized to an intracoronary infusion of enalaprilat or placebo, followed 10 min later by a PC protocol.
方法：22名行冠脉血管成形术的患者被随机分为两组，分别于冠脉内注射依那普利或安慰剂，随后进行缺血预处理试验。
Results: In control patients, the ST-segment shift was greater during the first inflation than during the second and third inflations, both on the intracoronary electrocardiogram (ECG) (21.0 ± 2.8 mm vs. 13.0 ± 2.0 mm and 13.0 ± 2.0 mm, p < 0.05) and the surface ECG (16.0 ± 4.0 mm vs. 10.0 ± 2.0 mm and 9.0 ± 2.0 mm, p < 0.05). In contrast, enalaprilat-pretreated patients showed no change in ST-segment shift during inflations on either the intracoronary or the surface ECG. During the first inflation, the ST-segment shift was significantly smaller in treated versus control patients. The chest pain score during the first inflation was also significantly smaller in treated patients versus control patients (33.0 ± 6.0 mm vs. 64.0 ± 6.0 mm) and did not change in treated patients during the second and third inflations, whereas it decreased significantly in control patients. In a subset of 6 patients, enalaprilat increased coronary blood flow during infusion, but this effect dissipated before the beginning of angioplasty.
结果：冠脉内心电图及体表心电图均显示，在对照组患者中，首次球囊扩张过程中ST段偏移度大于第二、第三次扩张，[冠脉内心电图ST段偏移度为21.0 ± 2.8 mm vs. 13.0 ± 2.0 mm and 13.0 ± 2.0 mm, p < 0.05;体表心电图ST段偏移度分别为16.0 ± 4.0 mm vs. 10.0 ± 2.0 mm and 9.0 ± 2.0 mm, p < 0.05]。与此相反的是，依那普利预处理组患者在球囊扩张过程中，无论是冠脉内心电图还是体表心电图均未发现ST段变化。依那普利预处理组在首次球囊扩张过程中ST段偏移度明显小于对照组（分别为33.0 ± 6.0 mm vs. 64.0 ± 6.0 mm)，在第二次、第三次球囊扩张过程中没有变化，而在对照组中，ST段偏移度在第二次、第三次球囊过程中明显减小。亚组分析（n=6）表明，依那普利预处理能增加灌注时的冠脉血流量，但这种效应血管成形术开始后消失。
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作者:admin@医学,生命科学 2011-03-05 17:14
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