Pouleur H, van Eyll C, Gurné O, Rousseau M F
Department of Physiology and Pharmacology, University of Louvain, Medical School, Brussels, Belgium.
Eur Heart J. 1992 Jul;13(7):952-9. doi: 10.1093/oxfordjournals.eurheartj.a060299.
The aim of this study was to clarify the mechanisms responsible for the increase in early filling rate observed during oral nisoldipine therapy in patients with ischaemic left ventricular (LV) dysfunction. For that purpose, the global and regional LV function was analysed before and after 2 months of double-blind monotherapy with nisoldipine (10 mg twice daily) or a placebo, in 17 patients with a previous anterior myocardial infarction. The baseline LV ejection fraction ranged from 34-51% and no patient had heart failure. Compared to the placebo, nisoldipine significantly lowered LV systolic pressure and end-diastolic pressure (-3 mmHg vs +6 with the placebo; P less than 0.01) and the LV pressure at the time of mitral opening (-2.0 +/- 3.4 mmHg vs +3.5 +/- 3.0; P less than 0.01). Despite this reduction in driving pressure, the global LV early peak filling rate improved with nisoldipine only and this improvement was related to a selective increase in expansion rate of the anterior areas, from 1010 +/- 360 to 1339 +/- 496 mm2.s-1 (P less than 0.001). The time to regional peak filling rate (-8%; P less than 0.01), the asynchrony of diastolic wall motion and the regional ejection fraction (33 +/- 10 to 38 +/- 12%; P less than 0.001) also improved in the anterior areas with nisoldipine but not with the placebo. In contrast, in the inferior, control zones, the regional ejection fraction and filling rate remained unchanged, both when compared to baseline and to the placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是阐明缺血性左心室（LV）功能障碍患者口服尼索地平治疗期间早期充盈率增加的机制。为此，对17例曾患前壁心肌梗死的患者进行了尼索地平（每日两次，每次10mg）或安慰剂双盲单药治疗2个月前后的整体和局部LV功能分析。基线LV射血分数范围为34%-51%，无患者患有心力衰竭。与安慰剂相比，尼索地平显著降低了LV收缩压和舒张末期压力（-3mmHg对比安慰剂组的+6mmHg；P<0.01）以及二尖瓣开放时的LV压力（-2.0±3.4mmHg对比+3.5±3.0mmHg；P<0.01）。尽管驱动压力有所降低，但仅尼索地平可使整体LV早期峰值充盈率提高，且这种改善与前部区域扩张率的选择性增加有关，从1010±360增加至1339±496mm²·s⁻¹（P<0.001）。尼索地平治疗后，前部区域的局部峰值充盈率时间（-8%；P<0.01）、舒张期壁运动的不同步性以及局部射血分数（从33±10%提高至38±12%；P<0.001）也有所改善，而安慰剂组则无此变化。相比之下，在下部对照区域，与基线和安慰剂相比，局部射血分数和充盈率均保持不变。（摘要截断于250字）
