Takaoka H, Takeuchi M, Odake M, Hayashi Y, Mori M, Hata K, Yokoyama M
1st Department of Internal Medicine, Kobe University School of Medicine, Japan.
J Am Coll Cardiol. 1993 Aug;22(2):598-606. doi: 10.1016/0735-1097(93)90071-8.
The aim of this study was to compare the effects of a phosphodiesterase inhibitor and catecholamine on arterial-ventricular coupling and myocardial energetics in the diseases human heart.
Recent experimental studies have indicated that the arterial-ventricular coupling analysis using the time-varying elastance model could discriminate between inotropic and vasoactive effects of the two agents.
With the use of a conductance catheter, left ventricular contractility and arterial afterload were measured from the slope of the end-systolic pressure-volume relation, Emax, and the slope of the end-systolic pressure-stroke volume relation, Ea. Arterial-ventricular coupling was assessed by Ea/Emax before and after administration of a new phosphodiesterase inhibitor, E-1020 (0.3 microgram/kg per min), and a beta 1-stimulant, dobutamine (5 micrograms/kg per min), in 20 patients with heart disease. Left ventricular mechanical efficiency was assessed as the ratio of stroke work to myocardial oxygen consumption per beat measured by the thermodilution method.
The slope of the end-systolic pressure-volume relation increased comparably with both E-1020 (39%, p < 0.01) and dobutamine (47%, p < 0.01), but Ea/Emax decreased with E-1020 (1.25 to 0.78, -37%, p < 0.01) more than with dobutamine (1.23 to 0.99, -16%, p < 0.05). Although stroke work index increased with both agents, myocardial oxygen consumption remained unchanged with E-1020 but increased with dobutamine (p < 0.05). Consequently, left ventricular mechanical efficiency increased with E-1020 (0.30 to 0.36, p < 0.05) but remained unchanged with dobutamine (0.27 to 0.29, p = NS).
The phosphodiesterase inhibitor E-1020 improved arterial-ventricular coupling more than did dobutamine, with a resultant increase in mechanical efficiency. These data were in accordance with the theoretic prediction of the coupling analysis in the diseases human heart.
本研究旨在比较磷酸二酯酶抑制剂和儿茶酚胺对患病人心脏动脉 - 心室耦合及心肌能量代谢的影响。
最近的实验研究表明，使用时变弹性模型进行动脉 - 心室耦合分析能够区分这两种药物的变力作用和血管活性作用。
使用电导导管，通过收缩末期压力 - 容积关系斜率（Emax）以及收缩末期压力 - 搏出量关系斜率（Ea）来测量左心室收缩力和动脉后负荷。在20例心脏病患者中，在给予新型磷酸二酯酶抑制剂E - 1020（0.3微克/千克每分钟）和β1激动剂多巴酚丁胺（5微克/千克每分钟）之前和之后，通过Ea/Emax评估动脉 - 心室耦合。通过热稀释法测量每搏的搏功与心肌氧耗量之比来评估左心室机械效率。
收缩末期压力 - 容积关系斜率在使用E - 1020（增加39%，p < 0.01）和多巴酚丁胺（增加47%，p < 0.01）时均有相当程度的增加，但E - 1020使Ea/Emax降低（从1.25降至0.78，降低37%，p < 0.01）的幅度大于多巴酚丁胺（从1.23降至0.99，降低16%，p < 0.05）。虽然两种药物均使搏功指数增加，但E - 1020使心肌氧耗量保持不变，而多巴酚丁胺使其增加（p < 0.05）。因此，E - 1020使左心室机械效率增加（从0.30增至0.36，p < 0.05），而多巴酚丁胺使其保持不变（从0.27至0.29，p = 无显著性差异）。
磷酸二酯酶抑制剂E - 1020比多巴酚丁胺更能改善动脉 - 心室耦合，从而使机械效率增加。这些数据与患病人心脏耦合分析的理论预测相符。
