Læknablaðið - 15.01.1994, Blaðsíða 51

LÆKNABLAÐIÐ
41
enalapril. ANP levels at one month correlated
negatively with the left ventricular ejection
fraction at the same time.
Plasma neurohormones were measured in 214
patients with mild to moderate chronic heart
failure, randomized to treatment with ramipril
or placebo for 3 months. There was a wide
variation in hormone levels. Noradrenaline
and aldosterone correlated negatively with
exercise duration at baseline. Noradrenaline
correlated positively with the degree of
symptoms. Aldosterone and ANP were
reduced on ramipril compared to placebo.
Noradrenaline was reduced among patients
with baseline levels in the highest tertile.
Plasma hormones were also measured at peak
exercise in 54 patients. Hormonal levels at
rest correlated strongly with those at peak
exercise. There was an inverse relationship
between exercise duration and angiotensin II
at maximal exercise. All hormones increased
significantly at peak exercise. ACE activity
and ANP at maximal exercise were reduced
by ramipril compared to placebo.
Sustained neurohormonal activation following
myocardial infarction mainly occurs in
patients with heart failure or extensive
myocardial damage. Such activation is
associated with subsequent left ventricular
dilatation and deterioration in systolic left
ventricular function. Despite a correlation
between the vasoconstrictor hormones and
exercise duration in patients with heart failure,
neurohormonal activation varies markedly
in patients with similar clinical symptoms.
Treatment with ACE inhibitors modestly
suppressed plasma neurohormonal levels.
Future therapy of patients with left ventricular
dysfunction may possibly be directed towards
further modulation of neurohormonal activity.