Clinical Potential of Oral Nicorandil to Improve Myocardial Fatty Acid Metabolism after Percutaneous Coronary Intervention in Hemodialysis Patients

Abstract

Background/Aims: The assessment of myocardial fatty acid metabolism impairment by single-photon emission computed tomography (SPECT) using ¹²³I-β-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the risk of cardiac death in hemodialysis patients. We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention (PCI) in this population. Methods: We evaluated 128 hemodialysis patients who had obtained coronary revascularization by PCI (90 men and 38 women, 66 ± 9 years). Participants for the analysis were randomly assigned to either the nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed every year after coronary revascularization by PCI. Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores (SS). Results: The incidence of cardiac death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in the control group (21/65, 32.3%) during a mean follow-up of 2.7 ± 1.4 years. BMIPP SS reduction rates improved in the nicorandil group compared with the control group from 3 years of administration. In Kaplan-Meier analyses, free survival rate of cardiac death was higher in patients with a ≥20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS reduction rate (p = 0.0001). In multiple logistic analysis, oral administration of nicorandil was associated with ≥20% reduction rates of BMIPP SS (odds ratio 2.823, p = 0.011). Conclusion: Long-term oral administration of nicorandil may improve impaired myocardial fatty acid metabolism after coronary revascularization by PCI in hemodialysis patients.

Effects of intravenous l-carnitine on myocardial fatty acid imaging in hemodialysis patients: responders or non-responders to l-carnitine

“…In the control group, the mean BMIPP SS did not differ between before and 12 months after carnitine administration (18.2 ± 6.0 versus 18.7 ± 6.4, n = 26) (Figure 2 a). Since we have reported that decrease in BMIPP SS <−20% might result in improving cardiac mortality of hemodialysis patients in our recent studies (Nishimura et al 2014 , 2015 ), we subdivided participants of the carnitine and control groups into the following three subgroups according to the changes in BMIPP SS: improved subgroup, changes in BMIPP SS <−20%; deteriorated subgroup, changes in BMIPP SS >20%; unchanged subgroup, changes in BMIPP SS ± 20%. In the control group ( n = 26), 2 (7.7%), 4 (15.4%), and 20 (76.9%) participants were allocated to the improved, deteriorated, and unchanged subgroup, respectively.…”

“…Sakurabayashi et al reported that chronic oral administration of l -carnitine to hemodialysis patients did not change myocardial accumulation of 123 I- β -methyliodophenyl pentadecanoic acid (BMIPP), an iodinated analogue of free FFA, or LV dimension or function, but it increased the washout rate of 123 I-BMIPP (Sakurabayashi et al 1999 ). However, no study has been reported regarding the effect of l -carnitine on single-photon emission computed tomography (SPECT) using 123 I-BMIPP, of which improvement may contribute to betterment of LV dysfunction or decrease in cardiac death (Nishimura et al 2006 , 2008a , b , 2011 , 2014 , 2015 ; Moroi et al 2013 ). In the present study, we investigated whether chronic intravenous administration of l -carnitine could improve impaired myocardial fatty acid imaging in patients on maintenance hemodialysis with LV dysfunction not based on obstructive coronary artery disease (CAD) or valvular heart diseases.…”

Clinical Value of99Tcm-MDP SPECT Bone Scintigraphy in the Diagnosis of Unilateral Condylar Hyperplasia

“…Routine imaging examinations, such as X-ray and CT, can only detect anatomical changes and not condylar growth activity. Single photon emission computed tomography (SPECT) has been commonly used to evaluate metabolism in several types of tissue [9–11]. Importantly, SPECT could provide both functional and morphological information associated with condylar hyperplasia [12].…”