重症心不全に対する新規Quinazoline系血管拡張剤，E-643の急性効果—血行動態，血漿カテコールアミンおよび血液ガスによる検討

Acut Effects of a New Antihypertensive Quinazoline Derivative, E-643 in Severe Heart Failure: Hemodynanics, Plasma Catecholamine Levels and Blood Gas Data

　心不全の治療は，従来，強心利尿剤が主をなしてきたが，近年，重症あるいは難治性心不全の治療対策の1つとして血管拡張剤による心室負荷軽減療法が注目されてきた。

　血管拡張剤には，主として末梢抵抗血管を拡張させるPhentolamine，Phenoxbenzamine，Hydralazine，容量血管を拡張させる亜硝酸製剤，その両作用を有するPrazosin，Nitroprusside等があり，その有効性が指摘されている^1〜15）。

　Simultaneous estimation of hemodynamics, catecholamine levels and blood gas data were performed in 10 patients with severe heart failure before and after administration of oral E-643 (2 mg), which is a long-acting, new antihypertensive quinazoline derivative. Effects occurred within 1 hour and persisted significantly for 12 hours after administration ; Peak effect was observed at 3 hours after administration. At peak effect, cardiac index increased from 2.42±0.16 L/min/M² to 2.90±0.17 L/min/M², mean right atrial pressure decreased from 9 mmHg to 5 mmHg. mean pulmonary capillary wedge pressure decreased from 26 mmHg to 18 mmHg, meanblood pressure decreased from 93 mmHg to 80 mmHg, systemic vascular resistance decreased from 1777 dynes･sec･cm^-5 to 1302 dynes･sec･ cm^-5. pulmonary vascular resistance decreased from 211 dynes･sec･cm^-5 to 142 dynes･sec･cm^-5, Double product decreased from 10662 to 8835, however heart rate remained unch anged. At 2 hours after administration arteriovenous oxygen diffcrence decreased from 7.1 ml/dl to 5.7 ml/dl, mean arterial oxygen pressure declined from 83 mmHg to 73 mmHg (not significant), mean venous oxygen pressure rose from 32 mmHg to 35 mmHg, where as there was no significant change in pH, B. E., carbon dioxide pressure and plasma catecholamine levels. Therefore E-643 seemed to be a potent vasodilator with both acting as preload and afterload reduction and so to be useful for the treatment of severe heart failure as a deloading agent.