Mechanical energetics in patients with left ventricular hypertrophy and/or dysfunction

左心室肥厚和/或功能障碍患者的机械能量学

• 批准号: 06670706
• 负责人: YOKOTA Mitsuhiro
• 金额: $ 1.34万
• 依托单位: Nagoya University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1994
• 资助国家: 日本
• 起止时间: 1994 至 1995
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-06670706/
• 关键词: Dilated Cardiomyopathy; Myocardial Energetics; Left Ventricular Pressure-volume Relations; Inotropic Agents; Ventriculoarterial Coupling; Myocardial Oxygen Consumption; Mechanical Efficiency; うっ血性心不全; 不全心; 肥大心; 機械的エネルギー効率; 非閉塞性肥大型心筋症; 局所エネルギー効

Idiopathic dilated cardiomyopathy is a fetal heart disease that severely compromises cardiac performance. One problem is that this disease is extremely resistant to therapy and no inotropic agent has been reported to decrease its mortality. Various aspects of this disease including the pathophysiology, hemodynemics have been analyzed and reported, but this study have focused on how these variable affect myocardial energetics. By means of left ventricular pressure-volume relations, we investigated left ventricular contractility, arterial loading conditions and the way their interaction affects myocardial energetics in patients with idiopathic dilated cardiomyopathy. The effects fo 3 inotropic agents including dobutamine, MS-857 and OPC-18790 with different mechanism of action were investigated. A phosphodiesterase inhibitor MS-857 and OPC-18790 works mainly by inhibiting phosphodiesterase, and OPC-18790 prolongs the action potential of myocyte.Methods. Pressure-volume data were measured in 33 patients with idiopathic dilated cardiomyopathy by using a conductance catheter, and myocardial oxygen consumption was obtained simultaneously by a double-themistor coronary sinus catheter (Wilton-Webster Laboratories). Fogarty catheter was placed in the inferior vena cava and was inflated transiently for the determination of left ventricular pressure-volume relation.Conclusions. The degree of ventriculoarterial coupling is far from optimal and the cardiovascular performance is severely depressed mechanically and energetically in patients with indiopathic dilated cardiomyopathy. Althought inotropic agents improve the coupling and increased the work efficiency, but not enough to optimize the coupling condition. It appears that myocardial oxygen utilization is regulated to maintain a constant mechanical efficiency.

特发性扩张型心肌病是一种严重影响心脏功能的胎儿心脏病。一个问题是，这种疾病是非常耐治疗和没有正性肌力药物已报告，以减少其死亡率。关于这种疾病的病理生理学、血流动力学等方面的研究已经有了很多报道，但目前的研究主要集中在这些变量对心肌能量学的影响。通过左心室压力-容积关系，我们研究了特发性扩张型心肌病患者的左心室收缩力、动脉负荷条件及其相互作用影响心肌能量学的方式。本文研究了多巴酚丁胺、MS-857和OPC-18790三种不同作用机制的正性肌力药物的作用。磷酸二酯酶抑制剂MS-857和OPC-18790主要通过抑制磷酸二酯酶发挥作用，OPC-18790抑制肌细胞动作电位。应用电导导管测定33例原发性扩张型心肌病患者的压力-容积数据，同时用双热敏电阻冠状窦导管测定心肌耗氧量。将Fogarty导管置入下腔静脉并短暂充盈以测定左心室压力-容积关系。原发性扩张型心肌病患者的心室动脉耦合程度远未达到最佳，心血管功能在机械和能量方面受到严重抑制。虽然正性肌力药物改善了偶联，提高了工作效率，但不足以优化偶联条件。看来，心肌氧利用率是受调节的，以维持恒定的机械效率。

项目成果

Sobue T,Yokota M,Iwase M,Ishihara H.: "Influence of left ventricular hypertrophy on left ventricular function during dynamic exercise in the presence or absence of coronary artery disease." Journal of the American College of Cardiology. 25. 91-98 (1995)

Sobue T，Yokota M，Iwase M，Ishihara H.：“在存在或不存在冠状动脉疾病的情况下，动态运动期间左心室肥厚对左心室功能的影响。”

Yokota M et al.: "Cardiac Energetics:From Emax To Pressure-Volume Area" Kluwer Academic Publishers,Boston,USA, 227 (1995)

Yokota M 等人：“心脏能量学：从 Emax 到压力-容积面积”Kluwer 学术出版社，波士顿，美国，227 (1995)

Ando A et al.: "Correlation between the exercise-induced in left ventricular filling pressure and the exetent of ischemic or infarcted myocardium." Japanese Circalation Journal. 59. 705-714 (1995)

Ando A 等人：“运动引起的左心室充盈压与心肌缺血或梗塞程度之间的相关性。”

Ishihara H,Yokota M,Sobue T,Saito H.: "Relation Between Ventriculoarterial Coupling and Myocardial Energetics in Patients With Idiopathic Dilated Cardiomyopathy." Journal of the American College of Cardiology. 23. 406-416 (1994)

Ishihara H、Yokota M、Sobue T、Saito H.：“特发性扩张型心肌病患者的心室动脉耦合与心肌能量学之间的关系”。

Ando A,Yokota M,Sobue T,Nishinaka Y,Iwase M,Hayashi H,Saito H.: "Correlation between the exercise-induced increase in left ventricular filling pressure and the extent of ischemic or infarcted myocardium." Japanese Circulation Journal. 59. 705-714 (1995)

Ando A，Yokota M，Sobue T，Nishinaka Y，Iwase M，Hayashi H，Saito H.：“运动引起的左心室充盈压增加与心肌缺血或梗塞程度之间的相关性。”