THE INFLUENCE OF LONG-TERM THERAPY WITH PERINDOPRIL ON THE HEART INOTROPIC FUNCTION IN PATIENTS WITH CHRONIC POSTINFARCTION ANEURISM

Aim. To study the influence of long-term therapy with perindopril on the heart inotropic function in patients with chronic postinfarction aneurism. Material and methods. 21 patients suffering ischemic heart disease with postinfarction cardiosclerosis, chronic aneurism of left ventricle and chronic heart failure of functional class III-IV according to NYHA were observed. All patients took perindopril, 2-4 mg daily. Before and after 6 months of therapy myocardial contractile function of left and right ventricles was studied by balanced radioventriculography with segmental and phase analysis of histogram. Results. In patients with chronic postinfarction aneurism significant structural and functional abnormalities were revealed: reduction of left ventricular ejection fraction up to 17,8 ± 3,2 %, the same for right ventricular up to 22,1±4,4 %, their considerable dilation with reduction of filling and expulsion velocity. After 6 months of therapy with  perindopril  improvement of clinic status of patients, tendency towards  increase of both ventricles general ejection fraction, enlargement of maximal filling velocity and filling velocity during 1/3 of diastole as well as tendency to reduction of both ventricles end diastolic and systolic volumes were registered. In left ventricle there were normokinetic zones in 35 (21%) segments, hypokinetic zones in 24 (14%), akinetic zones in 54 (32%) and dyskinetic zones in 17 (10%) segments. In right ventricle there were normokinetic zones in 45 (27%) segments, hypokinetic zones in 62(37%), akinetic zones in 54 (32%) and dyskinetic zones in 7 (4%) segments. After 6 months of therapy with perindopril tendency towards improvement of local myocardial contractility was registered. Conclusion. In patients with chronic postinfarction aneurism deterioration of general and local myocardial contractility were registered. Accurate link between left ventricle local myocardial contractility and localization of aneurism were not revealed. After 6 months of therapy with perindopril tendency towards improvement of general and local myocardial contractility of both ventricles was registered.

1. Morocutti G., Fontanelli A., Bernardi G. et al. Identification of patients at risk of post-infarction heart rupture. Clinical and therapeutic characteristics of 121 consecutive cases and review of the literature. Minerva Cardioangiol. 1995; 43(4): 117-126.

2. Benediktsson R., Eyjolfsson O., Thorgeirsson G. Natural history of chronic left ventricular aneurysm; a population based cohort study. J Clin Epidemiol. 1991;44 (11):1131-9.

3. Hochman J.S., Brooks M.M., Morris M. et al. Prognostic significance of left ventricular aneurysm in the Cardiac Arrhythmia Suppression Trial (CAST) population. Am Heart J. 1994;127(4 Pt 1): 824-832.

4. Белов Ю.В., Вараксин В.А Современное представление о постинфарктном ремоделировании левого желудочка. Русский медицинский журнал 2002; 10: 469-471.

5. Никитин Н.П., Аляви А.Л., Голоскокова В.Ю. и соавт. Особенности процесса позднего ремоделирования сердца у больных, перенесших инфаркт миокарда, и их прогностическое значение. Кардиология 1999; 1: 54-58.

6. Беленков Ю. Н. Особенности внутренней гемодинамики у больных с недостаточностью кровообращения различной этиологии. Дисс. … доктора мед. наук. М., 1986.

7. Ишемическое ремоделирование левого желудочка (методологические аспекты, вопросы диагностики и лечения)/Под ред. Л.А. Бокерия, Ю.А. Бузиашвили, И.В. Ключникова. М.: Издательство НЦССХ им. А.Н.Бакулева РАМН, 2002. 152 с.

8. Roscitano A., Capuano F., Simon C. et al. Left ventricular aneurysm repair: early survival. Ital Heart J. 2005 Feb;6(2):143-149.

9. Бокерия Л.А., Федоров Г.А. Опыт хирургического лечения постинфарктных аневризм левого желудочка сердца и сопутствующих желудочковых тахиаритмий (1981-199). Грудная и сердечно-сосудистая хирургия, 1999; 6: 38-44.

10. Zaliunas R., Babarskiene M.R., Kavoliuniene A. et al. Lethal outcomes in patients with symptomatic heart failure developed after Qwave myocardial infarction. Medicina. 2004;40(2):141-148.

11. Tonnessen T., Knudsen C.W. Surgical left ventricular remodeling in heart failure. Eur J Heart Fail. 2005 Aug;7(5):704-9.

12. Lundblad R., Abdelnoor M., Svennevig J.L. Repair of left ventricular aneurysm: surgical risk and long-term survival. Ann Thorac Surg. 2003 Sep;76(3):719-725.

13. Cohn J.N., Johnson G., Sabetai R. et al., for the V-HeFT VA Cooperative Studies Group. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio and plasma epinephrine as determinants of prognosis in the heart failure. Circulation 1993; 87: Suppl VI: 5-16.

14. D'Amico C.L. Cardiac transplantation: patient selection in the current era. J Cardiovasc Nurs. 2005; 20(5 Suppl): S4-13.

15. Stevenson L., Tillisch J., Hamilton M. et al. Importance of hemodynamic response to therapy in predicting survival with ejection fraction <20% secondary to ischemic or nonischemic dilated cardiomyopaty. Amer J Cardiol 1990; 66: 1348-1354.

16. De Groote P., Millaire A., Foucher-Hossein C. et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Amer Coll Cardiol 1998; 32: 948-954.

17. Poulsen S.H. , Jensen S.E., Moller J.E. et al. Prognostic value of diastolic function and assotiation with heart variability after a first acute myocardial infarction. Heart 2001; 86: 376-380

18. Cohn J.N., Ferrari R., Sharpe N. Cardiac remodeling – concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol 2000; 35: 569-582.

19. Flachskampf F.A., Voigt J.U. The interventricular septum is functionally bilayered: a fresh look at a well known structure. Heart. 2005; 91(10): 1260-12611.

20. Национальные рекомендации по диагностике и лечению ХСН, 2003.

21. Brown B., Hall A.S. Renin-angiotensin system modulation: the weight of evidence. Am J Hypertens. 2005;18 (9 Pt 2):127S-133S.

22. Ferrari R., Pasanisi G., Notarstefano P. et al. Specific properties and effect of perindopril in controlling the renin-angiotensin system.Am J Hypertens. 2005; 18(9 Pt 2): 142S-154S. Review.

23. Pfeffer J.M., Pfeffer M.A., Braunwald E. Influence of chronic captopril therapy on the infarcted left ventricle of the rat. Circ Res 1985; 57: 84-95.

24. Frigerio M., Roubina E. Drugs for left ventricular remodeling in heart failure. Am J Cardiol. 2005; 96(12S1): 10-18.

25. Cioffi G., Tarantini L., De Feo S. et al. Pharmacological left ventricular reverse remodeling in elderly patients receiving optimal therapy for chronic heart failure. Eur J Heart Fail. 2005; 7(6): 1040-1048.

26. Shibata M.C., Nilsson C., Hervas-Malo M. et al. Economic implications of treatment guidelines for congestive heart failure. Can J Cardiol. 2005; 21(14): 1301-1306.

27. de Kam P.J., Nicolosi G.L., Voors A.A. et al. Prediction of 6 months left ventricular dilatation after myocardial infarction in relation to cardiac morbidity and mortality. Application of a new dilatation model to GISSI-3 data. Eur Heart J. 2002; 23(7): 536-542.

28. Хурс Е.М. Механическое ремоделирование как критерий выбора тактики хирургического лечения при постинфарктных аневризмах левого желудочка. Автореф. дисс. канд.мед.наук. М., 1998.