Angiotensin-converting enzyme inhibition facilitates alveolar-capillary gas transfer and improves ventilation-perfusion coupling in patients with left ventricular dysfunction

被引:34
作者
Guazzi, M
Melzi, G
Marenzi, GC
Agostoni, P
机构
[1] Univ Milan, Ist Cardiol, I-20138 Milan, Italy
[2] IRCCS, Fondaz Monzino, CNR, Ctr Studio Ric Cardiovasc, Milan, Italy
关键词
D O I
10.1016/S0009-9236(99)70111-6
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objective: The backward effects of left ventricular dysfunction include alterations in alveolar-capillary gas transfer and ventilation-perfusion coupling. Because the angiotensin-converting enzyme (ACE) is highly concentrated in the vascular endothelium of the lungs, we examined whether ACE inhibitors may influence the pulmonary function in patients with congestive heart failure, Methods: In 20 patients with idiopathic cardiomyopathy, pulmonary function and exercise capacity were evaluated at baseline and 6 and 12 months after treatment with enalapril (10 mg twice a day) was started. The study also included 19 age- and sex-matched control subjects with mild primary hypertension and normal left ventricular function who were given enalapril as a standard treatment of high blood pressure. Results: In congestive heart failure, forced expiratory volume in 1 second, vital capacity, and total lung capacity did not vary significantly with enalapril; alveolar-capillary diffusion of carbon monoxide (DLCO) increased toward normal; exercise tolerance time, peak exercise oxygen uptake (peak V-O2), minute ventilation and tidal volume (peak VT) also increased; and the ratio of volume of dead space (VD) to VT (peak VD/VT) at peak exercise reduced. Changes in peak V-O2 showed a direct correlation with those in DLCO and an inverse correlation with those in peak VD/VT. Results at 6 and 12 months were comparable. Enalapril did not affect these variables in the control population, Conclusions: In patients with idiopathic cardiomyopathy heart failure, but not in control subjects, gas transfer and ventilation-perfusion improved with ACE inhibition. These pulmonary changes may contribute to the associated increase in exercise tolerance.
引用
收藏
页码:319 / 327
页数:9
相关论文
共 42 条
[1]   A NEW METHOD FOR DETECTING ANAEROBIC THRESHOLD BY GAS-EXCHANGE [J].
BEAVER, WL ;
WASSERMAN, K ;
WHIPP, BJ .
JOURNAL OF APPLIED PHYSIOLOGY, 1986, 60 (06) :2020-2027
[2]   ROLE OF ANGIOTENSIN-II AND PROSTAGLANDIN E(2) IN REGULATING CARDIAC FIBROBLAST COLLAGEN TURNOVER [J].
BRILLA, CG ;
ZHOU, GP ;
RUPP, H ;
MAISCH, B ;
WEBER, KT .
AMERICAN JOURNAL OF CARDIOLOGY, 1995, 76 (13) :D8-D13
[3]   IMPROVEMENT IN EXERCISE PERFORMANCE BY INHALATION OF METHOXAMINE IN PATIENTS WITH IMPAIRED LEFT-VENTRICULAR FUNCTION [J].
CABANES, L ;
COSTES, F ;
WEBER, S ;
REGNARD, J ;
BENVENUTI, C ;
CASTAIGNE, A ;
GUERIN, F ;
LOCKHART, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 326 (25) :1661-1665
[4]   THE LUNGS IN CHRONIC HEART-FAILURE [J].
CHUA, TP ;
COATS, AJS .
EUROPEAN HEART JOURNAL, 1995, 16 (07) :882-887
[5]   Exercise limitation in chronic heart failure: Central role of the periphery [J].
Clark, AL ;
PooleWilson, PA ;
Coats, AJS .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 28 (05) :1092-1102
[6]  
CLELAND JGF, 1985, BRIT HEART J, V54, P305
[8]   AIRWAY FUNCTION IN HEALTHY SUBJECTS AND PATIENTS WITH LEFT HEART-DISEASE [J].
COLLINS, JV ;
CLARK, TJH ;
BROWN, DJ .
CLINICAL SCIENCE AND MOLECULAR MEDICINE, 1975, 49 (03) :217-228
[9]   STRESS FAILURE OF ALVEOLAR EPITHELIAL-CELLS STUDIED BY SCANNING ELECTRON-MICROSCOPY [J].
COSTELLO, ML ;
MATHIEUCOSTELLO, O ;
WEST, JB .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 145 (06) :1446-1455
[10]   IRON-DEFICIENCY ANEMIA - ITS EFFECT ON TRANSFER FACTOR FOR LUNG (DIFFUSING CAPACITY) AND VENTILATION AND CARDIAC FREQUENCY DURING SUB-MAXIMAL EXERCISE [J].
COTES, JE ;
DABBS, JM ;
SAUNDERS, MJ ;
HALL, AM ;
ELWOOD, PC ;
MCDONALD, A .
CLINICAL SCIENCE, 1972, 42 (03) :325-+