Chatterjee K
University of California, San Francisco.
Basic Res Cardiol. 1989;84 Suppl 1:213-24. doi: 10.1007/BF02650361.
This paper reviews the effect on myocardial contractility, left ventricular afterload and left ventricular distensibility induced by the following phosphodiesterase inhibitors: Enoximone, piroximone, RO 13-6438, amrinone and milrinone. For all these compounds, direct positive inotropic effects have been shown in experimental studies. For amrinone and milrinone, a direct stimulating effect on myocardial contractility has been demonstrated by an increase in dP/dtmax when intracoronary applications of the compounds were performed. A direct stimulating effect on the myocardium was also demonstrated for enoximone and piroximone by analyzing the systolic pressure versus end-systolic volume ratio. For all of the phosphodiesterase inhibitors, a marked decrease of systemic vascular resistance has been observed indicating direct peripheral vasodilation. Although it has been demonstrated that phosphodiesterase inhibition increases left ventricular distensibility, the nature of this effect is not clear. For most of the phosphodiesterase inhibitors an increase in myocardial oxygen requirements was demonstrated due to overall contractility increase. However, these phosphodiesterase inhibitors induce increased coronary blood flow in excess so that a direct effect of these compounds on the coronary vasculature has been postulated. The clinical significance of such changes, however, remains unclear.
本文综述了以下磷酸二酯酶抑制剂对心肌收缩力、左心室后负荷和左心室舒张性的影响：依诺昔酮、吡罗昔酮、RO 13-6438、氨力农和米力农。对于所有这些化合物，实验研究均已表明其具有直接的正性肌力作用。对于氨力农和米力农，当进行冠状动脉内给药时，通过dP/dtmax的增加证明了它们对心肌收缩力具有直接刺激作用。通过分析收缩压与收缩末期容积比，也证明了依诺昔酮和吡罗昔酮对心肌具有直接刺激作用。对于所有磷酸二酯酶抑制剂，均观察到全身血管阻力显著降低，表明其具有直接的外周血管舒张作用。虽然已证明磷酸二酯酶抑制可增加左心室舒张性，但其作用性质尚不清楚。对于大多数磷酸二酯酶抑制剂，由于整体收缩力增加，心肌氧需求增加。然而，这些磷酸二酯酶抑制剂可使冠状动脉血流量过度增加，因此推测这些化合物对冠状动脉血管系统具有直接作用。然而，这种变化的临床意义仍不清楚。
