| Objective: Ischemic heart diseases have become the main cause of heart failure, which seriously affected the quality of life and brought huge economic burden to the society.The treatment of heart failure patients with ischemic heart disease has been improving left ventricular remodeling from strengthening the heart, diuresis, expansion of blood vessels to improve hemodynamics and great changes have taken place in the past ten years.ACEI could inhibit renin angiotensin aldosterone system, prevent angiotensin I converting to angiotensin II, inhibit the degradation of bradykinin and reduce the sympathetic nervous system activation and release of norepinephrine, which made blood vessel expansion,improving ventricular remodeling and heart function.ACEI could improve survival rate of heart failure patients, improve symptoms and quality of life, reduce adverse cardiovascular events.Majority of heart failure patients with post-myocardial infarction have a normol or low blood pressure,and perindopril may be the best choice and it could drop blood pressure slowly. Although many studies have confirmed that ACEI with high dose could better reduce cardiovascular death, non-fatal myocardial infarction and other adverse cardiovascular events than low dose,and more obviously improve quality of life and heart function of the patients. The application of high dose ACEI may appear low blood pressure, high potassium, dry cough and other adverse reactions which limitted clinical application, and ACEI was usually on the low side and small dose.The experiment was designed for investigating the efficacy and safty of perindopril on heart failure patients with ischemic heart diseases in different doses.Methods: Collectted heart failure patients with ischemic heart diseases from Feburary 2005 to Feburary 2015 whose New York cardiac function was class II ~ IV,and there are 110 cases in low-dose group(perindopril 2 ~ 4 mg/d) and 90 cases in high-dose group(perindopri 6 ~ 12 mg/d). Respectively detected left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular fraction shortening, serum glutamic pyruvic transaminase, creatinine, creatine kinase, total cholesterol,triglyceride,low density lipoprotein cholesterin,high density lipoprotein cholesterol,blood glucose,serum potassium,blood pressure and heart rate before or after treatment,then followed up by telephone about death, cardiac death and hospitalization for heart failure of the enrolled participants. Observed the efficacy and safty of perindopril on heart failure patients with ischemic heart diseases in different doses.Results: 1 Study found that about basic data characteristics,left ventricular end systolic diameter,left ventricular end diastolic diameter,left ventricular ejection fraction,left ventricular fraction shortening,serum glutamic pyruvic transaminase, creatinine, creatine kinase, total cholesterol, triglyceride,low density lipoprotein cholesterin,high density lipoprotein cholesterol,blood glucose,serum potassium,blood pressure and heart rate before treatment there were no obvious statistical significance between high dose and low dose(P>0.05).2 Low dose group:cardiac function before treatment: LVESD45.00[39.00, 49.25]mm, LVEDD58.00[54.75,62.00]mm,LVEF47.00 [43.00,52.00]%,LVFS 23.00[19.75,27.00]%,cardiac function after 6-mouth treatment: LVESD42.00 [37.00,47.00]mm, LVEDD56.00[53.00,60.00]mm,LVEF53.00[48.00,56.00]%, LVFS25.00[22.00,27.00]%,cardiac function after one-year treatment: LVESD 42.50[38.00,47.75] mm, LVEDD 56.00[53.00,60.75] mm,LVEF 53.00[48.00, 55.75]%,LVFS25.00[22.00,28.00]%, cardiac function after two-year treatment: LVESD43.00[38.75,47.00]mm, LVEDD55.00[52.75,60.00]mm, LVEF 54.00[49.00,56.00]%,LVFS25.00[22.00,28.00]%, cardiac function after threeyear treatment: LVESD43.00[40.00,47.50]mm, LVEDD56.00[53.00,60.00] mm,LVEF53.00[48.00,56.00]%,LVFS25.00[22.00,27.50]%, cardiac function after four-year treatment:LVESD42.00[39.00,47.00]mm, LVEDD56.00[53.00, 61.00] mm,LVEF 52.00 [48.00,55.50]%,LVFS 24.00 [22.00,28.00]%, cardiac function after five-year treatment:LVESD43.00[37.00,48.00]mm, LVEDD 58.00[53.00,60.00]mm,LVEF50.00[48.00,54.00]%,LVFS23.00[21.00,27.00]%, cardiac function after six-year treatment:LVESD42.00[37.00,47.00]mm, LVEDD56.00[53.00,60.00]mm,LVEF53.00[48.00,56.00]%,LVFS25.00[21.00,27.00]%. High dose group:cardiac function before treatment: LVESD46.00 [42.00,51.00]mm, LVEDD 59.00 [56.00,63.00] mm,LVEF 45.00 [42.00, 48.00]%,LVFS21.00[18.00,25.00]%, cardiac function after 6-month treatment: LVESD39.00[36.25,43.00]mm,LVEDD54.00[51.00,57.00]mm,LVEF53.00 [50.00,57.00]%,LVFS26.00[24.00,29.00]%, cardiac function after one-year treatment:LVESD39.50[37.00,44.00]mm,LVEDD54.00[51.00,58.00]mm, LVEF54.00[50.00,57.00]%,LVFS25.00[23.00,29.00]%, cardiac function after two-year treatment: LVESD40.00[38.00,43.00]mm, LVEDD53.00[50.00, 56.00]mm,LVEF 56.00 [50.00,59.00]%, LVFS 26.00 [24.00,29.00]%, cardiac function after three-year treatment:LVESD40.00[37.00,44.00]mm, LVEDD 54.00[51.00,58.00]mm,LVEF54.00[52.00,57.00]%,LVFS25.00[23.00,29.00]%, cardiac function after four-year treatment:LVESD41.00[38.00,44.00]mm, LVEDD55.00[52.00,58.00]mm,LVEF53.00[50.00,56.00]%,LVFS25.00[24.00,28.00]%, cardiac function after five-year treatment:LVESD41.00[37.00,45.00] mm, LVEDD 55.00 [51.00,58.00] mm, LVEF52.00[49.00,56.00]%,LVFS25.00 [23.00,28.00]%, cardiac function after six-year treatment:LVESD39.00 [36.00, 44.00]mm, LVEDD54.00[51.00,57.00]mm,LVEF53.00[49.00,57.00]%,LVFS 25.00[23.00,29.00]%.Cardiac function after treatment in low dose group obviously improved than before treatment as the same as in high dose group,and the difference of LVEF between low dose and high dose groups appeared after 6-month treatment.3 About serum glutamic pyruvic transaminase, creatinine, creatine kinase, total cholesterol,triglyceride,low density lipoprotein cholesterin,high density lipoprotein cholesterol,blood glucose,blood pressure and heart rate after treatment there were no obvious statistical significance between low dose and high dose groups(P>0.05),but the difference of serum potassium between low dose and high dose groups was statistical significance(P<0.05)when the followup-time was six years.Because Potassium levels of the two groups were both lower than the high normal range,there were no danger about using perindopril and we need closely monitor the potassium level.4 There were less cardiac death and hospitalization for heart failure in high dose group than low dose group(P<0.05),but there were no siginificant difference about all cause death between two groups(P>0.05).5 Logistic regression analysis found that cardiac death was associated with perindopril dose,coronary artery bypass graft, type 2 diabetes, aspirin and nitrate among which perindopril, type 2 diabetes, aspirin and nitrate were protective factors while coronary artery bypass graft was risk factor.The found was different from traditional concept.Maybe it was due to the difference about the basic data characteristics and it needed to be studied further.6 The optimal dose of perindopril in heart failure patients with ischemic heart disease was 8mg/d.7 Two survival cerves seperated from each other when the followup-time was at 20 mouths it was statistical significance(P<0.05).Conclusion:Perindopril could improve cardiac function and structure, reduce cardiac death and hospitalization for heart failure,obviously improve quality of heart failure patients with ischemic heart diseases.Furthermore,high dose perindopril was better than low dose and it was clinically safe.We need closely monitor the level of potassium. |
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