セロトニン拮抗剤の冠血流に及ぼす影響

The Effects of Sarpogrelate (5-HT2antagonist) on Coronary Artery Flow Velocity Dynamics

　塩酸サルポグレラート（5—HT₂antagonist）の冠血流に及ぼす急性効果を左冠動脈前下行枝（LAD）に有意狭窄がない虚血性心疾患8例（男性4例，平均61歳）を対象に検討した．ドプラガイドワイヤーをLAD近位部に留置し亜硝酸薬を冠注した後，平均最大冠血流速度（APV）を安静時およびATP30μg冠注後で測定し，両者の比から冠予備能（CFR）を算出した．さらに全身血行動態（血圧，心拍数，肺動脈圧，楔入圧，心拍出量）を測定した．その後塩酸サルポグレラート200mg経口投与し60分後に同様の測定をした．塩酸サルポグレラート投与によりCFRおよび塩酸サルポグレラート投与前後での全身血行動態および造影による冠動脈径には有意な変化は認めなかったが，安静時・ATP冠注後のAPVは，それぞれ17.5±9.1vs 19.1±9.5cm／sec,p＝0.03,54.6±23.2vs64.1±30.9cm／sec,p＝0.02と有意に増加した．塩酸サルポグレラートには微小冠血管拡張作用による冠血流増加作用があると考えられた．

We examined the rapid cardiovascular effects of sar-pogrelate (5-HT₂ antagonist) in 8 patients (4 male;average age 61 years) with ischemic heart disease whohad no significant coronary stenosis in the left anteriordescending artery (LAD). A dopplar guide wire waspositioned in the proximal portion of LAD, and isosor-bide dinitrate was administered intracoronarily. Thenwe measured the average peak velocity (APV) at restand peak hyperemic responses to intracoronary 30μgadenosine triphosphate (ATP). Coronary flow reserve(CFR) was calculated as the ratio of ATP-inducedhyperemic to baseline APV. In addition, we measuredblood pressure, heart rate and hemodynamic data(pulmonary arterial pressure, pulmonary capillarywedge pressure, cardiac output) using a Swan-Gantzcatheter. We repeated the measurements one hour aftera 200mg orally-administered sarpogrelate. Sarpogrelatedid not significantly change CFR, general hemodynamicdata or the diameter of LAD in coronary angiography,but increased APV at rest from 17.5±9.1 to 19.1±9.5cm/sec (p=0.03) and, at peak, hyperemic responses tointracoronary ATP were increased from 54.6±23.2 to64.1±30.9cm/sec (p=0.02). These findings indicate thata serotonin blocker, sarpogrelate, augments coronaryartery flow by coronary microcovasodilation.