Hasenfuss G, Holubarsch C, Heiss W H, Bonzel T, Meinertz T, Just H
Department of Internal Medicine, University of Freiburg, F.R.G.
Basic Res Cardiol. 1987;82 Suppl 2:403-9. doi: 10.1007/978-3-662-11289-2_39.
The effects of inhibition of phosphodiesterase by enoximone on left ventricular haemodynamics and myocardial energetics were investigated in 10 patients with idiopathic dilative cardiomyopathy. After intravenous administration of enoximone, there was a significant reduction of left ventricular systolic pressure from 126 +/- 21 to 93 +/- 16 mm Hg, of left ventricular end-diastolic pressure from 16 +/- 8 to 5 +/- 3 mm Hg and of left ventricular end-diastolic volume from 287 +/- 54 to 215 +/- 69 ml. Left ventricular pressure-volume work decreased significantly from 12.1 +/- 3.6 to 7.6 +/- 2.8 mm Hg.l. Heart rate was 87 +/- 17 before and 103 +/- 18 min-1 after administration of enoximone (p less than 0.01). Left ventricular systolic stress-time integral, a major determinant of myocardial oxygen consumption, decreased by 49% from 91 +/- 32 to 46 +/- 15 10(3) dyn.s/cm2 (p less than 0.01). In contrast myocardial oxygen consumption per beat was reduced by only 18%, from 138 +/- 28 to 113 +/- 17 microliters O2/100 g (p less than 0.01). The economy of myocardial contraction as calculated by the ratio of systolic stress-time integral to myocardial oxygen consumption per beat was 675 +/- 192 before and 370 +/- 128 dyn.s.100 g/cm2.microliter O2 after administration of enoximone. In conclusion, the phosphodiesterase inhibitor enoximone exhibits vascular and myocardial effects. The myocardial effects result in decreased economy of myocardial contraction. The possible molecular mechanisms of these energetic changes are discussed.
在10例特发性扩张型心肌病患者中研究了依诺昔酮抑制磷酸二酯酶对左心室血流动力学和心肌能量代谢的影响。静脉注射依诺昔酮后，左心室收缩压从126±21显著降至93±16mmHg，左心室舒张末期压力从16±8降至5±3mmHg，左心室舒张末期容积从287±54降至215±69ml。左心室压力-容积功从12.1±3.6显著降至7.6±2.8mmHg·l。给药前心率为87±17次/分钟，给药后为103±18次/分钟（p<0.01）。心肌耗氧量的主要决定因素左心室收缩期应力-时间积分从91±32降至46±15×10³dyn·s/cm²，降低了49%（p<0.01）。相比之下，每搏心肌耗氧量仅降低了18%，从138±28降至113±17μl O₂/100g（p<0.01）。依诺昔酮给药前每搏收缩期应力-时间积分与心肌耗氧量之比计算得出的心肌收缩经济性为675±192，给药后为370±128dyn·s·100g/cm²·μl O₂。总之，磷酸二酯酶抑制剂依诺昔酮具有血管和心肌效应。心肌效应导致心肌收缩经济性降低。讨论了这些能量变化可能的分子机制。
