皮膚経由のニトログリセリンパッチ療法により,左心室の機能が改善され,急性心筋梗塞の後の再構成が防止される:多センターの予期的なランダム化,ダブルブラインド,プラセボ対照試験の結果
J J Mahmarian1, L A Moyé, D A Chinoy
1Baylor College of Medicine, Houston, Tex, USA. johnj@bcm.tmc.edu
Circulation
|June 4, 1998
まとめ
断続的な経皮ニトログリセリン (NTG) パッチは,急性心筋梗塞 (AMI) の後の左心室 (LV) 拡張を効果的に予防します. LV機能が低下し,継続的な投与を必要とする患者では,最も低い用量でも利点が見られた.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
背景:
- 窒素は,急性心筋梗塞 (AMI) のアンギナに標準的なものです.
- 短期間の窒素使用制限 左心室 (LV) の膨張と心臓発作の拡大.
- Q波AMIの生存者におけるLVリモデルの長期的な影響は,あまり理解されていない.
研究 の 目的:
- AMIの生存者におけるLVリモデリングに対する断続的な経皮ニトログリセリン (NTG) パッチの6ヶ月の有効性を評価する.
- 最適な投与量とNTG療法から恩恵を受ける患者のサブグループを決定する.
主な方法:
- ランダム化,ダブルブラインド,プラセボ対照試験.
- 291人のAMI生存者はNTGパッチ (0.4,0.8,1.6mg/h) またはプラセボを受けた.
- 放射性核素動脈造影 (RNA) は,ベースラインと6ヶ月でLVの改造を評価した.
主要な成果:
- 0.4mg/hのNTG用量は,エンドシストリックボリューム指数 (ESVI) とエンドダイアストリックボリューム指数 (EDVI) を著しく低下させた.
- 利益は,ベースラインのLVエジェクション分数 ≤40%の患者で最も顕著でした.
- ESVIはNTGの撤退後に増加したが,ベースラインレベル以下にとどまった.
結論:
- トランスダーマルNTGパッチは,AMIの生存者におけるLVの拡張を防止します.
- 効果は用量依存 (0.4 mg/h) で,LV機能が低下した患者に特異的です.
- 持続的な効果のためには,NTGの継続的な投与が必要であり,臨床試験の結果が正当化されている.
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