Ghio S, De Servi S, Ferrario M, Poma E, Bramucci E, Angoli L, Specchia G
Divisione di Cardiologia, Policlinico S. Matteo, Pavia, Italy.
Eur Heart J. 1988 Jul;9(7):740-5. doi: 10.1093/eurheartj/9.7.740.
The effects of diltiazem on left ventricular systolic and diastolic function were studied in 14 patients with a recent (12-20 days) Q-wave myocardial infarction. Left ventriculography with simultaneous recording of high-fidelity left ventricular pressure was performed in control conditions, and after i.v. administration of diltiazem (0.2 mg kg-1 as a bolus followed by constant infusion of 0.005 mg kg-1 min-1 lasting 8-10 min). After the administration of the drug, left ventricular systolic pressure decreased by 12.7% and mean circumferential wall stress by 14% (both P less than 0.01); the heart rate did not change; the ejection fraction increased by 9.6% (P less than 0.05) and maximum dP/dt/P by 11% (P less than 0.01). Quantitative segmental wall motion analysis showed that the beneficial effects of diltiazem on global left ventricular systolic function were associated with an increase in contraction in hypokinetic regions, where they were supplied by normal or diseased coronary vessels (both P less than 0.01). Left ventricular end-diastolic pressure decreased by 23.6% (P less than 0.05) and minimal diastolic pressure by 38% (P less than 0.05). Passive diastolic properties of the left ventricular chamber remained unaltered but isovolumic relaxation markedly improved: the T constant decreased 26% (P less than 0.01). Thus, in patients with a recent Q-wave myocardial infarction, the i.v. administration of diltiazem unloads the left ventricular chamber without showing depressant effects on myocardial contractility.
在14例近期（12 - 20天）发生Q波心肌梗死的患者中研究了地尔硫䓬对左心室收缩和舒张功能的影响。在对照条件下以及静脉注射地尔硫䓬（0.2mg/kg静脉推注，随后以0.005mg/kg·min - 1持续静脉输注8 - 10分钟）后，进行了同步记录高保真左心室压力的左心室造影。给药后，左心室收缩压下降12.7%，平均圆周壁应力下降14%（均P<0.01）；心率未改变；射血分数增加9.6%（P<0.05），最大dP/dt/P增加11%（P<0.01）。定量节段性室壁运动分析表明，地尔硫䓬对整体左心室收缩功能的有益作用与运动减弱区域收缩的增加有关，这些区域由正常或病变的冠状动脉供血（均P<0.01）。左心室舒张末期压力下降23.6%（P<0.05），最小舒张压下降38%（P<0.05）。左心室腔的被动舒张特性保持不变，但等容舒张明显改善：T常数下降26%（P<0.01）。因此，在近期发生Q波心肌梗死的患者中，静脉注射地尔硫䓬可减轻左心室负荷，而对心肌收缩力无抑制作用。
