うっ血性心不全に対するIsosorbide dinitrate-Nifedipine併用投与の血行力学的効果

Hemodynamic Effects of Combined Isosorbide Dinitrate-Nifedipine Therapy in Congestive Heart Failure

　Ca^＋＋拮抗剤であるnifedipine　（NIF）が強力な抵抗血管拡張作用を有することは良く知られた事実である。著者らはNIFのこのような作用に着目し，重症高血圧症に対する降圧剤として^1），また，うっ血性心不全における血管拡張薬として使用しその効果を報告して来た^2）。

　著者らの成績ではNIFは末梢血管抵抗が著明に上昇し，かつ，心拍出量の低下を示すうっ血性心不全症例に有効であるが，肺うっ血の強い症例に対してはその急速な改善は望めない欠点を有していた^2）。

To determine whether combined isosorbide dinitrate (ISDN)-nifedipine (NIF) therapy might be useful in the treatment of congestive heart failure, this study was designed to compare hemo-dynamic effects of ISDN and combined ISDN-NIF administration. Nine patients with class III or IV congestive heart failure as defined by the NYHA were studied. In all patients pulmonary arterial and right atrial pressure were recorded with a Swan-Ganz catheter. Cardiac output wasmeasured by thermodilution technique. After obtainning the control values of hemodynamics, 5 mg of ISDN was administrated sublingually and the 2nd hemodynamic measurement was done 20 minutes thereafter. After the 2nd measurement, 2 mg of NIF was administrated sublingually and then, the 3rd hemodynamic measurement was done 30 minutes after NIF administration. After administration of combined ISDN-NIF, mean arterial blood pressre (MABP), PAEDP, LVSWI and total systemic vascular resistance index(TSVRI) were significantlly decreased as compared with these values of control measurement. After NIF administration, CI and SVI were significant-ly increased as compared with these values of 2nd measurement. In 6 patients who showed a high PAEDP (over 18 mmHg), the fall in PAEDP was accompanied by an increase in SVI after combined ISDN-NIF administration. These results indicate that combined ISDN-NIF therapy is beneficial to treat the patients with congestive heart failure.