Ito Kazuki, Sugihara Hiroki, Nishikawa Susumu, Adachi Yoshihiko, Kato Shuuji, Azuma Akihiro, Matsubara Hiroaki
Department of Cardiology, Murakami Memorial Hospital, Asahi University.
Kaku Igaku. 2003 Nov;40(4):421-30.
Sympathetic nerve system is activated as a compensatory mechanism in heart failure. However, excessive activation of sympathetic nerve system deteriorates disease state. Sympathetic nerve system can be suppressed with N-type Ca2+ channel blocker. An antihypertensive drug, cilnidipine, is a dual L/N-type Ca2+ channel blocker. We studies usefulness of cilnidipine in treating with chronic heart failure with 123I-MIBG myocardial scintigraphy. We enrolled 24 patients with stable chronic heart failure. Twelve patients were treated with ACE-inhibitors, diuretics and cardiotonics (control group), and the other 12 patients were treated with ACE-inhibitors, diuretics, cardiotonics and cilnidipine (cilnidipine group). We examined blood pressure, heart rate, norepinephrine level, brain natriuretic peptide (BNP) level, cardiothoracic ratio on chest X-ray, ejection fraction of left ventricle on two-dimensional echocardiography, count rate of heart to mediastinum (H/M) and washout rate (WOR) on 123I-MIBG myocardial scintigraphy before and six months after medication. Symptom was improved in 8 patients in the control group and 10 patients in the cilnidipine group after medication. And another parameters were also improved in the both groups after medication. However the degree of change in blood pressure (mmHg) was 21.2 +/- 8.0 in the cilnidipine group and 10.8 +/- 9.1 in the control group, that in heart rate (/min) was 24.1 +/- 6.8 and 16.2 +/- 11.0, that in BNP level (pg/ml) was 65.2 +/- 12.0 and 42.8 +/- 11.1, that in H/M was 0.30 +/- 0.08 and 0.19 +/- 0.09, that in WOR was 19.4 +/- 5.6 and 12.2 +/- 7.0, respectively. And the degree of these changes were larger in the cilnidipine group (p < 0.05). These findings suggested that cilnidipine, a dual L/N-type Ca2+ channel blocker, might be useful in treating with chronic heart failure.
在心力衰竭中，交感神经系统作为一种代偿机制被激活。然而，交感神经系统的过度激活会使疾病状态恶化。N型钙通道阻滞剂可抑制交感神经系统。抗高血压药物西尼地平是一种L/N型双重钙通道阻滞剂。我们通过123I-MIBG心肌闪烁显像研究了西尼地平治疗慢性心力衰竭的有效性。我们纳入了24例稳定的慢性心力衰竭患者。12例患者接受ACE抑制剂、利尿剂和强心剂治疗（对照组），另外12例患者接受ACE抑制剂、利尿剂、强心剂和西尼地平治疗（西尼地平组）。我们在用药前和用药六个月后检查了血压、心率、去甲肾上腺素水平、脑钠肽（BNP）水平、胸部X光片上的心胸比率、二维超声心动图上左心室的射血分数、123I-MIBG心肌闪烁显像上的心脏与纵隔计数率（H/M）和洗脱率（WOR）。用药后，对照组8例患者和西尼地平组10例患者的症状得到改善。用药后两组的其他参数也有所改善。然而，西尼地平组血压（mmHg）的变化程度为21.2±8.0，对照组为10.8±9.1；心率（/min）的变化程度为24.1±6.8和16.2±11.0；BNP水平（pg/ml）的变化程度为65.2±12.0和42.8±11.1；H/M的变化程度为0.30±0.08和0.19±0.09；WOR的变化程度分别为19.4±5.6和12.2±7.0。西尼地平组这些变化的程度更大（p<0.05）。这些发现表明，L/N型双重钙通道阻滞剂西尼地平可能对治疗慢性心力衰竭有用。
