西地那非治疗心力衰竭

    西地那非治疗充血性心力衰竭的临床研究表明，西地那非能改善充血性心力衰竭患者运动通气和缺氧状况，耐受良好。其作用机制主要与西地那非改善血管内皮细胞功能有关。用法：在常规用药的基础上口服西地那非50mg，一日2次，连续6个月。虽然西地那非治疗心力衰竭有一定的临床效果，但应注意该药的不良反应。

Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure

Marco Guazzi, MD, PhD,Michele Samaja, PhD, Ross Arena, PhD,Marco Vicenzi, MD,Maurizio D.Guazzi, MD, PhD, JACC, 2007, 50(22): 2136-44

Objectives:This study sought to test the functional exercise capacity and endothelial function in a cohort of chronic heart failure (CHF) patients treated with chronic type 5 phosphodiesterase (PDE5) inhibitor.Background:In CHF, endothelial dysfunction is involved in muscle underperfusion, ergoreflex oversignaling, and exercise ventilation inefficiency. Inhibition of PDE5 by improving endothelial dysfunction might be beneficial.Methods:Stable CHF patients were randomly assigned to placebo (23 patients) or sildenafil at the dose of 50 mg twice per day (23 patients) in addition to their current drug treatment for 6 months, with assessments (at 3 and 6 months) of endothelial function by brachial artery flow-mediated dilatation (FMD), cardiopulmonary exercise testing, and ergoreflex response.Results:In the sildenafil group only, at 3 and 6 months we observed reduction of systolic pulmonary artery pressure (from 33.7 to 25.2 mm Hg and 23.9 mm Hg), ergoreflex effect on ventilation (from 6.9 to 2.3 l·min−1 and 1.9 l·min−1), ventilation to CO2 production slope (VE/Vco2, from 35.5 to 32.1 and 29.8), and breathlessness (score) (from 23.6 to 16.6 and 17.2), and an increase of FMD (from 8.5% to 13.4% and 14.2%), peak Vo2 (from 14.8 to 18.5 ml·min−1·kg−1 and 18.7 ml·min−1·kg−1), and ratio of Vo2 to work rate changes (from 7.7 to 9.3 and 10.1). All changes were significant at p < 0.01. In the sildenafil group, a significant correlation was found at 3 and 6 months between changes in FMD and those in ergoreflex. Changes in ergoreflex correlated with those in peak Vo2 and VE/Vco2 slope. No adverse effects were noted except for flushing in 3 patients.Conclusions:In CHF, improvement in exercise ventilation and aerobic efficiency with sildenafil is sustained and is significantly related with an endothelium-mediated attenuation of exercising muscle oversignaling. Chronic sildenafil seems to be a remedy based on CHF pathophysiology and devoid of remarkable adverse effects.

名词解释：

Ergoreflex:骨骼肌动力反射；

Flow Mediated Dilatation，FMD：肱动脉血流介导扩张反应。