Tassani Peter, Schad Hubert, Heimisch Werner, Bernhard-Abt Angelika, Ettner Ursula, Mendler Nikolaus, Lange Rüdiger
Department of Anaesthesiology, German Heart Centre Munich, Lazarettstr 36, D-80636 München, Germany.
Cardiovasc Drugs Ther. 2002 Sep;16(5):435-41. doi: 10.1023/a:1022190503351.
The calcium sensitizer levosimendan (LEV) improves the function of stunned myocardium, cardiac performance in heart failure, and possibly the efficiency of myocardial work. The present experiments investigated the effect of LEV on myocardial contraction and metabolism of acutely ischaemic myocardium distal to a functionally effective coronary artery stenosis. Anaesthetised open chest pigs (n = 14) were instrumented to assess heart rate (HR), aortic pressure (AoP), cardiac output (CO), blood flow in the left descending (QLAD) and circumflex (QLCX) coronary artery, myocardial end-diastolic segment length and systolic shortening (edL, MSS by sonomicrometry) in the LAD- and LCX-territory. Systemic vascular resistance (SVR), and a myocardial power index (PowI) for the LAD- and LCX-region were calculated. Following obstruction of QLAD by an external snare proximal to the first diagonal branch LEV was given intravenously (10 + 20 + 30 microg/kg 15 min apart, n = 8) or the vehicle of LEV (n = 6). Following LEV haemodynamics and regional myocardial performance changed significantly: HR +22 min(-1), AoP -6 mmHg, CO +17%, SVR -21%; intact myocardium: QLCX +15%, RLCX -24%, PowILCX + 39%; ischaemic myocardium: QLAD -7%, MSSLAD -42%, PowILAD -27%. The data confirm the pharmacological profile of LEV: positive chronotropy, positive inotropy, and vasodilatation. The pump function of acutely ischaemic myocardium worsened following LEV. The efficiency of myocardial performance did not improve. A beneficial effect of LEV on the function of ischaemic myocardium was possibly outmanoeuvred by the increase in heart rate.
钙增敏剂左西孟旦（LEV）可改善顿抑心肌的功能、心力衰竭时的心脏性能，并可能提高心肌做功效率。本实验研究了LEV对功能有效的冠状动脉狭窄远端急性缺血心肌的心肌收缩和代谢的影响。对14只麻醉开胸猪进行仪器安装，以评估心率（HR）、主动脉压（AoP）、心输出量（CO）、左前降支（QLAD）和回旋支（QLCX）冠状动脉血流量、LAD和LCX区域的心肌舒张末期节段长度和收缩期缩短（通过超声心动图测量的edL、MSS）。计算全身血管阻力（SVR）以及LAD和LCX区域的心肌功率指数（PowI）。在第一对角支近端用外部圈套器阻断QLAD后，静脉注射LEV（10 + 20 + 30 μg/kg，间隔15分钟，n = 8）或LEV的溶媒（n = 6）。给予LEV后，血流动力学和局部心肌性能发生显著变化：HR增加22次/分钟，AoP降低6 mmHg，CO增加17%，SVR降低21%；正常心肌：QLCX增加15%，RLCX降低24%，PowILCX增加39%；缺血心肌：QLAD降低7%，MSSLAD降低42%，PowILAD降低27%。数据证实了LEV的药理学特性：正性变时性、正性变力性和血管舒张作用。急性缺血心肌的泵功能在给予LEV后恶化。心肌做功效率未提高。LEV对缺血心肌功能的有益作用可能被心率增加所抵消。
