| The chronic heart failure is a common clinical syndrome. Various heart diseases may develop to heart failure. We regarded heart failure mechanism as hemodynamic abnormal in the past time, so we took treatmeat of correcting hemodynamic abnormal. This kind of traditional treatment of correcting hemodynamic abnormal can't improve prognosys and reduce death rate. Now many tests show the basic mechanism of heart failure is myocardial remodeling, which is a central feature in the process of my cardial failure. This process, which is related to renin-angiotensin-aldosterone system (RAAS). The angiotensin-converting enzyme inhibitors can resist the RAAS. But the escape of aldosterone sterone produced in patients with left ventricular dysfunction treated with an angiotensin – converting enzyme inhibitor. It is very importmant for us to take addition of aldosterone inhibitor to angiotensin–converting enzyme inhibitor in heart failure. The objective of the study is to compare the effect the inhibitory of angiotensin–converting enzyme Ramipril and aldosterone antagonist–Spironolactone on left vertricular remodeling and ventricular arrhythmia . We slected 60 patients with heart failure , in which 38 cases are male and 22 cases are female, from the patients in department of candiovasology of our hospital. The dignosis was lined with the Framingham (American) criterion and heart failure was graded by the NYHA, arrhythmia was assessed by twenty four hours electrocardiography. A total of 60 patients with heart failure were entered into study, 30 patients were randomized to conventional treatment group, 30 patients gived Ramipril and Spironolactone treatment group. The patients in Ramipril and Spironolactone were preseribed Ramipril 2.5~5mg and Spiromolactone 20mg everyday besides the rountine treatment. The treatment continued until the end of the 8th week. The LVEDV,LVESV and LVEF were measured by VIVID FIVE echocardiogram at the 1th day and the end of week of the 8th treatment. The ventricular arrhythmia was assessed by twenty four hours electrocardiography. The results were showed by mean±standard deviation. T test was used to compare the differences of parameters between two groups and analysis of variance was used to compare the differences among groups. P<0.05 shows there are significant differences among groups . The results in the studies are showed as follows : changes of LVEDV/LVESV and LVEF in pre-therapy and post-therapy. LVEDV,LVESV obviously decrease and LVEF increases compared the 8th weekend with the 1th day in heart failure patients after rountine treatment. The cardiac function and LVEF obviously improve in the two groups compared the 8th weekend with the 1th day. There is no obvious difference on cardiac function between rountine group and therapy group after the end of the 8 th week treatment. The ventricular arrhythmia obviously decreases on therapy group in pre-therapy and post–therapy. Now many studies show that the essence of heart failure was the changes of structure of the ventricle, which was caused by some biochemical factors, nerve endocrine system was activated,such as renin-angintensin-aldosterone system, norepinephrine, consist of a variety of molecular and cellule events that can lead to important changes in myocardial remodeling. The central feature of myocardial remodeling is an increase in myocardial mass associated with a change in the shape of the ventricle and an increase in ventricular volume. Renin-angiotensin-aldosterone system (RAAS) has the potential to act directly on cardiac cells, independently of its vascular and metabolic actions, thereby affecting myocardial remodeling. Angiotensin increases protein synthesis in cardiac myocytes and DNA synthesis in cardiac fibroblasts. In addition, angiotensin can cause apoptosis in cardiac myocytes in culture. Many scientists think RAAS is a central feature in the process of myocardial remodeling in heart failure . In this study we take ACEI-Ramipril countact RAAS,SAS. Ramipril can eff...
|
PDF Full Text Request