Moriuchi M, Saito S, Tamura Y, Kaseda N, Tsuji M, Tokutake E, Yumikura S, Hibiya K, Ozawa Y, Hatano M
J Cardiogr Suppl. 1986(9):77-85.
The effect of long-term vasodilator therapy (hydralazine, ecarazine or budralazine + isosorbide dinitrate) were evaluated for 20 patients with chronic congestive heart failure due to dilated cardiomyopathy (DCM) resistant to conventional therapy. There were 16 men and four women whose ages ranged from 30 to 74 years (mean 52 years). Fifteen patients were in NYHA class III, and five in class IV. All patients continued their previous therapeutic regimens during this study. Hemodynamic measurements were performed with a triple lumen flow-directed balloon-tipped catheter for 15 patients to evaluate the effects of vasodilator therapy. In the other five patients, heart rate, blood pressure, chest radiography for heart size (CTR) and M-mode echocardiography were monitored. The hemodynamic responses to the combined vasodilator therapy for 15 patients showed significant decreases in afterload and preload concomitant with an increase in cardiac output. The noninvasive evaluations of combined vasodilator therapy in five patients resulted in significant improvement in heart size and ejection fraction. In all 20 patients, symptoms were significantly improved. Side effects and drug toxicity were uncommon during vasodilator therapy. It is concluded that combined vasodilator treatment is the most ajunctive therapy for the management of severe refractory heart failure due to DCM. In addition, long-term nonparenteral vasodilators can be administered even in an outpatient clinic without hemodynamic monitoring.
对20例因扩张型心肌病（DCM）导致的慢性充血性心力衰竭且对传统治疗耐药的患者，评估了长期血管扩张剂治疗（肼屈嗪、乙卡嗪或布屈嗪+硝酸异山梨酯）的效果。患者中有16名男性和4名女性，年龄在30至74岁之间（平均52岁）。15例患者为纽约心脏协会（NYHA）心功能Ⅲ级，5例为Ⅳ级。在本研究期间，所有患者继续其先前的治疗方案。对15例患者使用三腔血流导向气囊导管进行血流动力学测量，以评估血管扩张剂治疗的效果。对另外5例患者监测心率、血压、心脏大小的胸部X线摄影（心胸比率）和M型超声心动图。15例患者联合血管扩张剂治疗后的血流动力学反应显示，后负荷和前负荷显著降低，同时心输出量增加。5例患者联合血管扩张剂治疗的非侵入性评估结果显示心脏大小和射血分数有显著改善。所有20例患者的症状均有显著改善。血管扩张剂治疗期间副作用和药物毒性不常见。结论是，联合血管扩张剂治疗是DCM所致严重难治性心力衰竭管理的最辅助治疗方法。此外，即使在门诊诊所，也可在无血流动力学监测的情况下给予长期非肠道血管扩张剂。
