The Significance Of The Change Of Neurohormones And Ejection Force In Patients With Congestive Heart Failure Before And After Treatment

OBJECTIVE: To study the changes of plasma neurohormonal hormones in patients with congestive heart failure before and after treatment with and without cilazapril and the effects of angiotension梒onverting enzyme inhibitors (ACEI )on these hormones and the role Qf ejection force in assessing cardiac systolic function. KETHODS:t. The present studies were performed in normal subjects (n=28) and in patients with mild (New York Heart Association[NYHA] class II, n45) and severe (NYHA class HI, n=22; NYHA IV, N22)heart failure. 2.59 patients with congestive heart failure (CHF) due to various heart diseases were divided into 2 groups with cilazapril or without ACEI at random. 3. Blood samples were collected before and after therapy and plasma neuropeptide Y(NPY), ealcitonin gene-related peptide(CGRP), natriuretic peptide(ANP) and C-type natriuretic peptide(CNP) were analyzed by radioimmunoassay.4.The ejection force was calculated in 25 patients ~without valve diseases and arrhythmia and 28 normal subjects by echocardiography; when 25 patients were infused with nitroglycerin for 15 minutes and the ejection force was checked again. RESULTS: 1. The values of plasma NPY, CGRP, ANP and CNP were significant iiy increased in both mild and severe CHF compared with that in normal subjects (P<0. 01 or P(O. 05).2. With worsening left ventricular dysfunction , the values of NPY, CGRP and ANP were increased and CGRP,ANP had statistical significance (P<0.01),where NPY had not. In contrast, CNP had not relationship with heart function (P>0. 05). 3. In patients who were divided into 2 groups with cilazapril and without ACEI treatment, the values of these hormones had not significant changes before and after treatment In (P>0.05).4. The patients had lower lever of the ejection force of left atrium and left ventricle than that in control subjects, but had not statistical significantly value (p>O. 05) when ejection force was normalized by ratio of left ventricle or left atrium to aortic cross梥ectional area or mitral valve area, it was significantly decreased (p0.05).7.Left atrial diameter, left atrial maximal volume and minimal volume were significantly enlarged in patienls with heart failure as compared to control group. but after nitroglycerin infusion for l5minutes, they had obvious changes(P(0.05 or P(0.01).8.\ormalized LAF had a negative correlation with ANP (r?. 75, P(O. 01). CONCLUSION: 1. Plasmatic NPY may indicate the severity of heart failure, while plasmatic CGRP and ANP show cardiac compensatory activation in patients with CHF.2.cilazapril has not a direct effects on the changes of these hormones. 3. Ejection force may be a more simple and reliable index for assessing cardiac systolic function in practice.