Yabe Y, Morishita T
Cardiovascular Diagnostic Laboratory Center, Toho University School of Medicine, Tokyo, Japan.
Jpn Heart J. 1987 Sep;28(5):675-86. doi: 10.1536/ihj.28.675.
Systemic and coronary hemodynamic effects of acebutolol (10 mg i.v.), a cardioselective beta-adrenoceptor blocking agent were investigated in 11 patients with coronary artery disease and significant arterial obstructive lesions. Efficacy was assessed by simultaneous left and right heart catheterization and with an inlaying Webster thermodilution catheter in the coronary sinus. The data were compared with data from 7 other patients who received 2 mg i.v. of propranolol, a non-cardioselective beta-blocker. With acebutolol, (1) the heart rate was reduced significantly (p less than 0.001), (2) no significant changes were observed in the LVSP, LVEDP, mean PWP, LVmax dp/dt/p, LV negative dp/dt/p, CI, SWI and SPI, (3) CSF and MVO2 decreased significantly (p less than 0.01) 5 min after injection and (4) the CVR showed a significant elevation (p less than 0.05) after 5 min. With propranolol, (1) the heart rate decreased significantly (p less than 0.05), (2) there were no significant changes in LVSP and LVEDP, (3) the mean PWP increased significantly (p less than 0.05), (4) the LVmax dp/dt/p, CI and SWI decreased significantly (p less than 0.05), (5) the CSF and MVO2 decreased markedly (p less than 0.01) and (6) the CVR increased markedly (p less than 0.01). As compared to the effects of 2 mg i.v. of propranolol, those produced by acebutolol (10 mg i.v.) were characterized by a predominant negative chronotropic action with minimal negative inotropic action, combined with a reduction in CSF and MVO2. The findings suggest that the efficacy of acebutolol in pump failure caused by myocardial ischemia during effort angina is mediated by improvement of the myocardial oxygen demand-supply imbalance.
在11例患有冠状动脉疾病且存在明显动脉阻塞性病变的患者中，研究了心脏选择性β - 肾上腺素能阻滞剂醋丁洛尔（静脉注射10毫克）对全身和冠状动脉血流动力学的影响。通过同时进行左右心导管插入术以及在冠状窦内放置韦伯热稀释导管来评估疗效。将这些数据与另外7例接受静脉注射2毫克普萘洛尔（一种非心脏选择性β受体阻滞剂）的患者的数据进行比较。使用醋丁洛尔时，（1）心率显著降低（p < 0.001），（2）左心室收缩压（LVSP）、左心室舒张末压（LVEDP）、平均肺毛细血管楔压（PWP）、左心室最大dp/dt/p、左心室负dp/dt/p、心脏指数（CI）、每搏功指数（SWI）和射血分数（SPI）均未观察到显著变化，（3）注射后5分钟脑脊液流量（CSF）和心肌耗氧量（MVO2）显著降低（p < 0.01），（4）5分钟后冠状动脉阻力（CVR）显著升高（p < 0.05）。使用普萘洛尔时，（1）心率显著降低（p < 0.05），（2）LVSP和LVEDP无显著变化，（3）平均PWP显著升高（p < 0.05），（4）LVmax dp/dt/p、CI和SWI显著降低（p < 0.05），（5）CSF和MVO2显著降低（p < 0.01），（6）CVR显著升高（p < 0.01）。与静脉注射2毫克普萘洛尔的效果相比，醋丁洛尔（静脉注射10毫克）产生的效果以主要的负性变时作用为主，负性变力作用最小，同时伴有CSF和MVO2的降低。研究结果表明，醋丁洛尔在劳力性心绞痛期间心肌缺血所致泵衰竭中的疗效是通过改善心肌氧供需失衡介导的。
