Pitts W R, Vongpatanasin W, Cigarroa J E, Hillis L D, Lange R A
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9047, USA.
Circulation. 1998 Apr 7;97(13):1270-3. doi: 10.1161/01.cir.97.13.1270.
In dogs, a large amount of intravenous cocaine causes a profound deterioration of left ventricular (LV) systolic function and an increase in LV end-diastolic pressure. This study was done to assess the influence of a high intracoronary cocaine concentration on LV systolic and diastolic function in humans.
In 20 patients (14 men and 6 women aged 39 to 72 years) referred for cardiac catheterization for the evaluation of chest pain, we measured heart rate, systemic arterial pressure, LV pressure and its first derivative (dP/dt), and LV volumes and ejection fraction before and during the final 2 to 3 minutes of a 15-minute intracoronary infusion of saline (n=10, control subjects) or cocaine hydrochloride 1 mg/min (n=10). No variable changed with saline. With cocaine, the drug concentration in blood obtained from the coronary sinus was 3.0+/-0.4 (mean+/-SD) mg/L, similar in magnitude to the blood cocaine concentration reported in abusers dying of cocaine intoxication. Cocaine induced no significant change in heart rate, LV dP/dt (positive or negative), or LV end-diastolic volume, but it caused an increase in systolic and mean arterial pressures, LV end-diastolic pressure, and LV end-systolic volume, as well as a decrease in LV ejection fraction.
In humans, the intracoronary infusion of cocaine sufficient in amount to achieve a high drug concentration in coronary sinus blood causes a deterioration of LV systolic and diastolic performance.
在犬类中，大量静脉注射可卡因会导致左心室（LV）收缩功能严重恶化以及左心室舒张末期压力升高。本研究旨在评估高冠状动脉内可卡因浓度对人类左心室收缩和舒张功能的影响。
在20例因胸痛接受心脏导管检查的患者（14例男性和6例女性，年龄39至72岁）中，我们在15分钟冠状动脉内输注生理盐水（n = 10，对照组）或盐酸可卡因1mg/min（n = 10）的最后2至3分钟之前和期间，测量了心率、体动脉压、左心室压力及其一阶导数（dP/dt）、左心室容积和射血分数。输注生理盐水时各项指标均无变化。使用可卡因时，从冠状窦采集的血液中药物浓度为3.0±0.4（均值±标准差）mg/L，与死于可卡因中毒的滥用者报告的血液可卡因浓度相似。可卡因未引起心率、左心室dP/dt（正向或负向）或左心室舒张末期容积的显著变化，但导致收缩压和平均动脉压升高、左心室舒张末期压力升高、左心室收缩末期容积增加以及左心室射血分数降低。
在人类中，冠状动脉内输注足以在冠状窦血液中达到高药物浓度的可卡因会导致左心室收缩和舒张功能恶化。
