Wortmann A, Bachmann K, Deuber H J, Roth E
Z Kardiol. 1986;75 Suppl 3:68-76.
Although nitrates are among the oldest drugs in cardiology the problem of tolerance is a scientific challenge of today. We examined and compared the effects of initial and chronic therapy (4 weeks) with 1 X 1 ISDN 120 mg sustained release in 9 patients with coronary heart disease and impaired left ventricular function. At intraindividually identical workloads (average 50 +/- 12 watt) there was a reduction of PCWPm from 32.5 +/- 9.5 to 19.7 +/- 9.8 mm Hg. This reduction of PCWPm during bicycle ergometry was fully achieved in long-term therapy. With the first dose of ISDN cardiac index (CI) at maximum workload increased from 6.0 +/- 1.2 to 6.8 +/- 1.3 l/min/m2; during chronic therapy cardiac index improved from 5.3 +/- 1.3 to 6.6 +/- 1.1 l/min/m2. Exercise capacity during bicycle ergometry in the sitting position increased concomitantly from 414 to 686 watt X min. In long-term therapy there was a further significant improvement to 772 watt X min. ST-segment depression, measured as sum of ST-depression in all 12 standard ECG leads decreased from 0.63 mV before medication to 0.11 mV after the first dose and to 0.16 mV in long-term therapy. The investigation of ventricular function during ventriculography and the investigation of coronary vasomotion during coronary angiography after ergonovine maleate i.v. and ISDN s.l. also demonstrated the full nitrate effect in long-term therapy.
尽管硝酸盐是心脏病学中最古老的药物之一，但耐受性问题仍是当今的一项科学挑战。我们研究并比较了9例冠心病且左心室功能受损患者初始治疗和长期治疗（4周）使用1×1 ISDN 120 mg缓释剂的效果。在个体相同的工作量（平均50±12瓦）下，肺毛细血管楔压均值（PCWPm）从32.5±9.5 mmHg降至19.7±9.8 mmHg。在长期治疗中，自行车运动试验期间PCWPm的这种降低完全实现。首次服用ISDN时，最大工作量下的心指数（CI）从6.0±1.2升/分钟/平方米增加到6.8±1.3升/分钟/平方米；长期治疗期间，心指数从5.3±1.3升/分钟/平方米改善至6.6±1.1升/分钟/平方米。坐位自行车运动试验期间的运动能力相应地从414瓦·分钟增加到686瓦·分钟。长期治疗中进一步显著改善至772瓦·分钟。以所有12个标准心电图导联ST段压低总和衡量的ST段压低，用药前为0.63 mV，首次用药后降至0.11 mV，长期治疗时为0.16 mV。静脉注射马来酸麦角新碱和舌下含服ISDN后，心室造影时对心室功能的研究以及冠状动脉造影时对冠状血管运动的研究也证实了长期治疗中硝酸盐的充分作用。
