心不全患者に対する経口強心剤"DENOPAMINE（TA−064）"の急性効果および慢性効果について

Acute and chronic effects of oral cardiotonic agent, Denopamine (TA-064) in patients with heart failure

　心不全の治療には主として，Digitalis剤および利尿剤が用いられてきたが，最近．第三の治療法として血管拡張剤による心室負荷軽減療法が確立されたと言ってよいであろう^1〜8）。しかし，これらの薬剤を使用しても効果の乏しい難治性心不全が依然として存在する。

　DoPamine，Dobutamineはこれらに対して有効であるが，静脈内投与しかできず，その作用は限定されている。本邦で新たに開発された経口強心剤であるDeno—pamineは陽性変力作用をもち，変時作用が少ないとされている。今回，我々は本剤の急性心不全および難治性心不全に対する効果を臨床的ならびに血行力学的に検討し，その有効性を示唆する知見を得たので文献的考察を加え報告する。

Hemodynamic effects of Denopamine were studied in 11 patients with acute heart failure and 15 patients with chronic heart failure. Upon completion of base-line measurements with Swan-Ganz catheter in 11 patients with acute heart failure, 10mg of Denopamine was administered orally and hemodynamic measurement were made over the ensuing 6 hours.

Upon completion of baseline measurements with UCG, 15mg of Denopamine were administered in 45 patients with chronic refractory heart failure and 30mg of Denopamine in 35 patients for 2 weeks.

Result : 1) 60 minutes after 10mg administration, cardiac index was significantly increased from 2.8± 0.23 I min/m² to 3.1±0.28 //min/m² (p <0.005) and stroke volume index was also increased. Pulmonary capillary wedge pressure was significantly decreased. 2) In chronic heart failure, left ventricular systolic dimension was significantly decreased and % fractional shortening was significantly increased from 26. 1±1.6% to 29.8±1.5% with 15mg administration and from 25.6 ±1.7% to 29.5±1.6% with 30mg administration. Mean blood pressure and heart rate were unchanged.

These data indicate that Denopamine is a potent inotropic agent and effective in patients with congestive heart failure who are treated with digitalis and diure-tic agents.