Morcos N C, Gardin J M, Tomita N, Henry W L
Department of Medicine, University of California, Irvine.
Basic Res Cardiol. 1992 Sep-Oct;87(5):437-51. doi: 10.1007/BF00795056.
Normal aging in man is known to be associated with a reduction in left-ventricular diastolic function, including the rates of relaxation and filling. Calcium channel blockers have been reported to improve left-ventricular diastolic function in patients with various forms of heart disease. Clinically, the action of calcium channel blockers may be related to either a direct myocardial effect or may be secondary to the peripheral or coronary vasodilation effects. The purpose of this study is to investigate a possible direct effect of calcium channel blockers on modulation of the reported age-related reduction in myocardial relaxation. The direct effects on myocardial relaxation of the dihydropyridine calcium channel blocker, nifedipine, were studied in isolated, perfused interventricular septa and left-ventricular wall from eight young (ages 9 to 18 months) and 14 old (ages 3 to 5 years) rabbits. Septa were perfused with oxygenated Ringer's solution and paced at 48 beats/min. Maximum relaxation velocity per unit of developed tension [-dT/dt]/T, and relaxation time per unit of developed tension tR/T were continuously measured before and after infusion of calcium channel blockers. In absence of drugs, the older rabbits demonstrated a mean [-dT/dt]/T which was 32% lower (p < 0.003) and a mean tR/T which was 45% higher (p < 0.005) than the younger rabbits. When nifedipine was introduced at concentrations > 10(-8) M equivalent to doses above the therapeutic free-plasma concentration in humans, all contraction and relaxation parameters were depressed. However, at lower doses, equivalent to doses in the clinical therapeutic range, [-dT/dt]/T was increased in the older rabbit septa by 18% in the presence of nifedipine. tR/T was shortened in the older rabbit septa by 17% in the presence of nifedipine. Myocardial relaxation in older rabbits after drug infusion approximated these parameters in the younger rabbits prior to drug infusion (P = NS). Calcium channel blockers had similar beneficial effects on the relaxation properties of the myocardium in younger rabbits. All beneficial effects were observed at concentrations of calcium channel blockers which were within and below the clinically therapeutic range of plasma free drug concentration, i.e., 5 x 10(-9) to 4 x 10(-8) M. Potential differences in relaxation effects related to different segments of the myocardium and different mechanical recording vectors were evaluated. Isolated left ventricle preparations from aging rabbits demonstrated improvements in tR/T and [-dT/dt]/T similar to those observed in the septum. Furthermore, improvement in mechanical function along the y-axis and x-axis vectors of the septum was similar.(ABSTRACT TRUNCATED AT 400 WORDS)
众所周知,人类的正常衰老与左心室舒张功能下降有关,包括舒张速率和充盈速率。据报道,钙通道阻滞剂可改善各种形式心脏病患者的左心室舒张功能。临床上,钙通道阻滞剂的作用可能与直接心肌效应有关,也可能继发于外周或冠状动脉血管舒张效应。本研究的目的是调查钙通道阻滞剂对所报道的与年龄相关的心肌舒张功能下降的调节可能存在的直接作用。在来自8只年轻(9至18个月大)和14只年老(3至5岁)兔子的离体灌注室间隔和左心室壁中,研究了二氢吡啶类钙通道阻滞剂硝苯地平对心肌舒张的直接作用。用含氧的林格氏液灌注室间隔,并以48次/分钟的频率起搏。在输注钙通道阻滞剂前后,连续测量每单位舒张张力的最大舒张速度[-dT/dt]/T和每单位舒张张力的舒张时间tR/T。在无药物的情况下,年老兔子的平均[-dT/dt]/T比年轻兔子低32%(p<0.003),平均tR/T比年轻兔子高45%(p<0.005)。当以>10(-8)M的浓度引入硝苯地平,相当于高于人类治疗性游离血浆浓度的剂量时,所有收缩和舒张参数均降低。然而,在较低剂量下,相当于临床治疗范围内的剂量,在存在硝苯地平的情况下,年老兔子室间隔的[-dT/dt]/T增加了18%。在存在硝苯地平的情况下,年老兔子室间隔的tR/T缩短了17%。药物输注后年老兔子的心肌舒张功能接近年轻兔子在药物输注前的这些参数(P=无显著性差异)。钙通道阻滞剂对年轻兔子心肌的舒张特性也有类似的有益作用。所有有益作用均在钙通道阻滞剂浓度处于和低于血浆游离药物浓度的临床治疗范围内时观察到,即5×10(-9)至4×10(-8)M。评估了与心肌不同节段和不同机械记录向量相关的舒张效应的潜在差异。来自衰老兔子的离体左心室制剂显示出tR/T和[-dT/dt]/T的改善与在室间隔中观察到的类似。此外,沿着室间隔y轴和x轴向量的机械功能改善相似。(摘要截断于400字)