Todo Y, Ohyanagi M, Fujisue R, Iwasaki T
Hyogo College of Medicine, Nishinomiya, Japan.
J Nucl Med. 1988 Apr;29(4):451-9.
In order to select the optimal vasodilator for the treatment of patients with congestive heart failure (CHF), the acute effects of three vasodilators (isosorbide dinitrate (ISDN) 5 mg, nifedipine 10 mg, and prazosin 1 mg) on peripheral capacitance and resistance vessels (CV and RV) were evaluated by a newly devised radionuclear technique (Study 1). Thirty-six patients with chronic CHF were divided into Group A (ejection fraction (EF) greater than or equal to 35%, n = 20, mean EF: 47.2 +/- 6.5%) and B (EF less than 35%, n = 16, mean EF: 24.8 +/- 7.1%). ISDN produced the strongest CV dilatation (25% in both groups). Nifedipine reduced RV tone in Groups A and B (14% and 27%, respectively), and CV tone in Group A (6%). Prazosin had the most prominent effects on both vessels in Group B. From these results, it appeared: (a) ISDN is indicated for the cases with increased CV tone, (b) nifedipine is suitable for those with increased RV tone, (c) in cases of increased tone in both vessels, nifedipine (when EF greater than or equal to 35%) or prazosin (when EF less than 35%) is optimal. To evaluate the validity of this assignment, 49 subjects with CHF were divided into Group 1 (n = 16, increased CV tone), Group 2 (n = 17, increased RV tone), and Group 3 (n = 16, increased CV and RV tone) in Study 2. In Group 1, the changes of all indexes were not significantly different between the subjects treated with optimal drug based on the assignment (subgroup P) and those with a non-optimal drug (subgroup N) after 2 wk of therapy. In Group 2, however, improvements of RV tone, EF, and exercise duration in subgroup P were greater than those in subgroup N (31 versus 10%, 21 versus 0%, 41 versus 14%, respectively). In Group 3, the results were the same as in Group 2 (34 versus 19%, 24 versus 8%, 26 versus 9%). These findings suggested that the selection of the optimal vasodilator based on peripheral hemodynamic evaluation with a newly devised radionuclear technique permits more effective treatment of chronic CHF.
为了选择治疗充血性心力衰竭（CHF）患者的最佳血管扩张剂，采用一种新设计的放射性核素技术评估了三种血管扩张剂（硝酸异山梨酯（ISDN）5毫克、硝苯地平10毫克和哌唑嗪1毫克）对周围容量血管和阻力血管（CV和RV）的急性作用（研究1）。36例慢性CHF患者分为A组（射血分数（EF）大于或等于35%，n = 20，平均EF：47.2±6.5%）和B组（EF小于35%，n = 16，平均EF：24.8±7.1%）。ISDN产生最强的CV扩张作用（两组均为25%）。硝苯地平降低A组和B组的RV张力（分别为14%和27%），降低A组的CV张力（6%）。哌唑嗪对B组的两种血管有最显著的作用。从这些结果来看：（a）ISDN适用于CV张力增加的病例；（b）硝苯地平适用于RV张力增加的病例；（c）在两种血管张力均增加的病例中，硝苯地平（当EF大于或等于35%时）或哌唑嗪（当EF小于35%时）是最佳选择。为了评估这种用药方案的有效性，在研究2中将49例CHF患者分为1组（n = 16，CV张力增加）、2组（n = 17，RV张力增加）和3组（n = 16，CV和RV张力均增加）。在1组中，治疗2周后，根据用药方案接受最佳药物治疗的亚组（P亚组）和接受非最佳药物治疗的亚组（N亚组）之间，所有指标的变化无显著差异。然而，在2组中，P亚组的RV张力、EF和运动持续时间的改善大于N亚组（分别为31%对10%、21%对0%、41%对14%）。在3组中，结果与2组相同（34%对19%、24%对8%、26%对9%）。这些发现表明，基于新设计的放射性核素技术进行外周血流动力学评估来选择最佳血管扩张剂，可以更有效地治疗慢性CHF。
