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尼索地平对肥厚型心肌病患者心功能和运动耐量的短期及长期影响。

Short- and long-term effects of nisoldipine on cardiac function and exercise tolerance in patients with hypertrophic cardiomyopathy.

作者信息

Tokushima T, Utsunomiya T, Ogawa T, Kidoh K, Ohtsubo Y, Ryu T, Yoshida K, Ogata T, Tsuji S, Matsuo S

机构信息

Department of Internal Medicine Saga Medical School, Japan.

出版信息

Basic Res Cardiol. 1996 Jul-Aug;91(4):329-36. doi: 10.1007/BF00789305.

DOI:10.1007/BF00789305
PMID:8874782
Abstract

UNLABELLED

Nisoldipine is a second generation dihydropyridine calcium antagonist having characteristics of strong coronary artery dilating effect and less negative inotropic action. The purpose of this study was to evaluate the effect of nisoldipine on the cardiac function (systolic and diastolic) and the exercise tolerance, in patients with hypertrophic cardiomyopathy (HCM).

SUBJECTS

Twenty-three patients with HCM were studied.

METHODS

We measured the following indices using M-mode and pulsed wave Doppler echocardiography before and after nisoldipine therapy; left ventricular fractional shortening (LVFS), isometric relaxation time (IRT), deceleration half-time (DHT) of early diastolic mitral (E) flow, late diastolic mitral (A) flow and A/E ratio. Symptom-limited treadmill exercise test was performed. Exercise tolerance (EX) time was measured. Nisoldipine of 10 mg/day was orally administered. Same tests were repeated on day 14 and after 6 months.

RESULTS

  1. Short-term effects; LVFS did not change (55.9 +/- 5.9%-->57.0 +/- 7.4%, NS) after 2 weeks. However, LV diastolic function significantly improved (IRT; 92.1 +/- 7.7 ms-->85.2 +/- 11.6 ms, p < 0.05, DHT; 70.7 +/- 16.2 ms-->63.3 +/- 3.7 ms, p < 0.05). EX time increased (8.9 +/- 2.6 min-->10.0 +/- 3.3 min, p < 0.05), 2) Long-term effects; LV diastolic function had a tendency toward improvement, but is statistically not significant (IRT; 91.1 +/- 7.6-->83.8 +/- 11.6 ms, DHT; 73.1 +/- 23.4-->61.0 +/- 11.4 ms, A/E; 1.26 +/- 0.29-->1.11 +/- 0.36) after 6 months. EX time was significantly increased (9.4 +/- 1.7--> 10.1 +/- 1.7 min, p < 0.05).

CONCLUSIONS

Nisoldipine improved LV diastolic dysfunction and exercise tolerance in patients with HCM. These effects were similar to the first generation calcium antagonists. LV diastolic dysfunction may be improved due to the reduction of intracellular calcium concentration and the relief of myocardial ischemia by strong coronary artery dilating effect. However, nisoldipine did not affect the LV systolic function because of its less negative inotropic effect.

摘要

未标注

尼索地平是第二代二氢吡啶类钙拮抗剂，具有冠状动脉扩张作用强、负性肌力作用小的特点。本研究旨在评估尼索地平对肥厚型心肌病（HCM）患者心功能（收缩和舒张）及运动耐量的影响。

研究对象

对23例HCM患者进行了研究。

方法

在尼索地平治疗前后，我们使用M型和脉冲波多普勒超声心动图测量了以下指标；左心室缩短分数（LVFS）、等容舒张时间（IRT）、舒张早期二尖瓣（E）血流减速半衰期（DHT）、舒张晚期二尖瓣（A）血流及A/E比值。进行了症状限制的平板运动试验。测量了运动耐量（EX）时间。口服10mg/天的尼索地平。在第14天和6个月后重复相同的测试。

结果

1）短期效应；2周后LVFS无变化（55.9±5.9%→57.0±7.4%，无显著性差异）。然而，左心室舒张功能显著改善（IRT；92.1±7.7ms→85.2±11.6ms，p<0.05，DHT；70.7±16.2ms→63.3±3.7ms，p<0.05）。EX时间增加（8.9±2.6分钟→10.0±3.3分钟，p<0.05）。2）长期效应；6个月后左心室舒张功能有改善趋势，但无统计学意义（IRT；91.1±7.6→83.8±11.6ms，DHT；73.1±23.4→61.0±11.4ms，A/E；1.26±0.29→1.11±0.36）。EX时间显著增加（9.4±1.7→10.1±1.7分钟，p<0.05）。

结论

尼索地平改善了HCM患者的左心室舒张功能障碍和运动耐量。这些作用与第一代钙拮抗剂相似。左心室舒张功能障碍可能因细胞内钙浓度降低及冠状动脉扩张作用强缓解心肌缺血而得到改善。然而，由于其负性肌力作用小，尼索地平未影响左心室收缩功能。

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