Department for Cardiology, Hungarian Defence Forces - Medical Centre, Budapest, Hungary.
Heart-Lung Clinic, University Hospital Örebro, Örebro, Sweden.
Adv Exp Med Biol. 2018;1067:31-45. doi: 10.1007/5584_2017_112.
The use of direct acting vasodilators (the combination of hydralazine and isosorbide dinitrate -Hy+ISDN-) in heart failure with reduced ejection fraction (HFrEF) is supported by evidence, but rarely used.However, treatment with Hy+ISDN is guideline-recommended for HFrEF patients who cannot receive either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers due to intolerance or contraindication, and in self-identified African-American HFrEF patients who are symptomatic despite optimal neurohumoral therapy.The Hy+ISDN combination has arterial and venous vasodilating properties. It can decrease preload and afterload, decrease left ventricular end-diastolic diameter and the volume of mitral regurgitation, reduce left atrial and left ventricular wall tension, decrease pulmonary artery pressure and pulmonary arterial wedge pressure, increase stroke volume, and improve left ventricular ejection fraction, as well as induce left ventricular reverse remodelling. Furthermore, Hy+ISDN combination has antioxidant property, it affects endothelial dysfunction beneficially and improves NO bioavailability. Because of these benefits, this combination can improve the signs and symptoms of heart failure, exercise capacity and quality of life, and, most importantly, reduce morbidity and mortality in well-defined subgroups of HFrEF patients.Accordingly, this therapeutic option can in many cases play an essential role in the treatment of HFrEF.
直接作用的血管扩张剂（肼屈嗪和硝酸异山梨酯的组合 - Hy+ISDN-）在射血分数降低的心力衰竭（HFrEF）中的应用得到了证据的支持，但很少使用。然而，对于由于不耐受或禁忌而不能接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的 HFrEF 患者，以及在接受最佳神经激素治疗后仍有症状的自我认定为非裔美国人心力衰竭患者，Hy+ISDN 治疗是指南推荐的。Hy+ISDN 组合具有动脉和静脉扩张血管的特性。它可以降低前负荷和后负荷，降低左心室舒张末期直径和二尖瓣反流容积，减少左心房和左心室壁张力，降低肺动脉压和肺动脉楔压，增加每搏量，改善左心室射血分数，并诱导左心室逆重构。此外，Hy+ISDN 组合具有抗氧化特性，它对内皮功能障碍有有益的影响，并提高一氧化氮的生物利用度。由于这些益处，这种联合治疗可以改善心力衰竭的体征和症状、运动能力和生活质量，最重要的是，降低明确的 HFrEF 患者亚组的发病率和死亡率。因此，这种治疗选择在许多情况下可以在 HFrEF 的治疗中发挥重要作用。
