他达拉非对冠状动脉疾病患者心肌血流的影响。

Effects of tadalafil on myocardial blood flow in patients with coronary artery disease.

作者信息

Weinsaft Jonathan W, Hickey Kathleen, Bokhari Sabahat, Shahzad Arsalan, Bedding Alun, Costigan Timothy M, Warner Margaret R, Emmick Jeffrey T, Bergmann Steven R

机构信息

Department of Medicine, Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, New York 10003, USA.

出版信息

Coron Artery Dis. 2006 Sep;17(6):493-9. doi: 10.1097/00019501-200609000-00001.

DOI:10.1097/00019501-200609000-00001

PMID:16905960

Abstract

OBJECTIVE

Erectile dysfunction and coronary artery disease share similar risk factors. Although phosphodiesterase-5 inhibitors used to treat erectile dysfunction do not adversely affect hemodynamic parameters in patients with coronary artery disease, their effects on myocardial blood flow are unknown.

METHODS

In a randomized, double-blind, crossover study we examined the effects of tadalafil, 20 mg, compared with placebo on myocardial blood flow in patients with stable coronary artery disease (n=7, 52-73 years old). After tadalafil or placebo, myocardial blood flow was measured with positron emission tomography (nine-segment model) at rest, during maximal coronary hyperemia with adenosine, and during increased myocardial work with dobutamine. Abnormal flow was defined as myocardial blood flow <75% of maximum perfusion during adenosine plus placebo (46 normal/17 abnormal segments dentified).

RESULTS

Compared with placebo, tadalafil had no significant effect on global myocardial blood flow at rest, during adenosine infusion, or during dobutamine infusion. Similarly, in normal and abnormal segments, tadalafil versus placebo had no significant effect on resting myocardial blood flow or on adenosine-induced increases in myocardial blood flow. In normal segments, myocardial blood flow with dobutamine plus tadalafil was greater than that with dobutamine plus placebo (1.79+/-0.56 versus 1.56+/-0.37 ml/g per min, P<0.01), and in abnormal segments, there was a trend for tadalafil compared with placebo to increase myocardial blood flow during dobutamine infusion (1.46+/-0.44 versus 1.36+/-0.36 ml/g per min, P=0.7).

CONCLUSIONS

Tadalafil had no significant effect on global myocardial blood flow at rest, during adenosine infusion, or during dobutamine infusion. Compared with placebo, tadalafil significantly augmented myocardial blood flow during increased workload in normal regions, with a trend toward improving myocardial blood flow in poorly perfused regions.

摘要

目的

勃起功能障碍和冠状动脉疾病有相似的危险因素。虽然用于治疗勃起功能障碍的磷酸二酯酶-5抑制剂对冠状动脉疾病患者的血流动力学参数无不良影响，但其对心肌血流的影响尚不清楚。

方法

在一项随机、双盲、交叉研究中，我们比较了20mg他达拉非与安慰剂对稳定型冠状动脉疾病患者（n = 7，年龄52 - 73岁）心肌血流的影响。服用他达拉非或安慰剂后，通过正电子发射断层扫描（九段模型）测量静息状态、腺苷诱发最大冠状动脉充血时以及多巴酚丁胺增加心肌做功时的心肌血流。异常血流定义为腺苷加安慰剂时心肌血流<最大灌注量的75%（共识别出46个正常节段/17个异常节段）。

结果

与安慰剂相比，他达拉非在静息状态、腺苷输注期间或多巴酚丁胺输注期间对整体心肌血流无显著影响。同样，在正常和异常节段，他达拉非与安慰剂相比，对静息心肌血流或腺苷诱导的心肌血流增加均无显著影响。在正常节段，多巴酚丁胺加他达拉非时的心肌血流大于多巴酚丁胺加安慰剂时的心肌血流（分别为1.79±0.56与1.56±0.37 ml/g每分钟，P<0.01），在异常节段，与安慰剂相比，他达拉非在多巴酚丁胺输注期间有增加心肌血流的趋势（分别为1.46±0.44与1.36±0.36 ml/g每分钟，P = 0.7）。