カルペリチドの間欠投与が有効であった陳旧性広範囲心筋梗塞の1例

Beneficial Effects of Intermittent Carperitide Therapy in an Outpatient with Old Broad Myocardial Infarction

患者は広範囲前壁梗塞を発症した57歳男性である．梗塞慢性期に標準的な内服治療にもかかわらず高度の肺高血圧が残存し，血中BNP濃度も高値を示した．以後，急性心不全を反復した．内科的治療では予後不良と考えられるこの症例に対して外来にてカルペリチドの間欠投与を施行した．約半年間の間欠投与(0.0125～0.025μg/kg/min×3時間/回×3回/週)により肺動脈圧や血中BNP濃度の著しい改善を認め，入院することなくNYHA IIで外来通院が可能となっている．重症慢性心不全に対する外来カルペリチド間欠投与の可能性につき文献的考察を交えて報告する．

Summary

　The patient, who was a 57-year-old male had broad anterior old myocardial infarction. We found that he had severe pulmonary hypertension and high plasma BNP level although he had received the maximum medical therapy in the chronic phase of myocardial infarction. Worsening of heart failure was repeated under the tailored therapy. We tried intermittent outpatient therapy to avoid his readmission for worsening heart failure. The pulmonary artery pressure and the plasma BNP level were decreased after a half-year of treatment with intermittent carperitide therapy(0.0125～0.025μg/min/kg, for 3 hours, 3 times a week). The patient has needed no hospitalization for worsening of heart failure and is stable in the NYHA functional class II. We assess the possibility for one therapeutic modality of intermittent carperitide therapy in outpatients with severe chronic heart failure.