Impact of Chronotropic Effect of Cilostazol After Acute Myocardial Infarction Insights From Change in Left Ventricular Volume and Function

Abstract

eft ventricular (LV) dysfunction and remodeling after acute myocardial infarction (AMI) are precursors of the development of heart failure and predictors of prognosis. 1 Cardiac remodeling is influenced by hemodynamic load, neurohormonal activation and other factors still under investigation. 2 Among them, heart rate (HR) has been identified as one of the predictors of the development of heart failure 3 and the change in LV volume and its function. 4 Cilostazol, a type III phosphodiesterase inhibitor, is an antiplatelet agent with vasodilating properties. It has been used for the reduction of intermittent claudication and as an antiplatelet agent in patients undergoing coronary stenting. A frequent observation in cilostazol studies is a positive chronotropic effect. [5][6][7] However, because of the action mechanism of a phosphodiesterase inhibitor, there have been concerns about the cardiovascular safety of cilostazol in patients with LV dysfunction. 8,9 Furthermore, little is known about the clinical experience with cilostazol in AMI patients. 10 In addition, data about the impact of its chronotropic effect on LV remodeling and function have not yet been reported in this population.Therefore, we evaluated the effect of cilostazol on LV volume and function in patients with AMI. Methods Study PopulationThe study was performed with institutional review board approval and informed consent from each subject. We retrospectively evaluated 56 AMI patients who underwent primary coronary stenting and were discharged alive. Eighty-three AMI patients from October 2003 to September 2004 were firstly drawn from the institutional patient database. Inclusion criteria were confirmed AMI, successful primary coronary stenting with grade 3 flow by the Thrombolysis in Myocardial Infarction trial classification within 6 h of the onset of symptoms or between 6 and 12 h if there was evidence of continuing ischemia. AMI was identified by clinical symptoms, initial ECG showing a new ST segment, T wave changes or left bundle branch block, and an increase in the serum creatine kinase myocardial isoform (CK-MB) value above twice the upper reference limit of 3.5 ng/ml. Serial measurement of CK-MB was performed at baseline, and at 6, 12 and 24 h. Patients were excluded if they were in Killip class IV heart failure or cardiogenic shock, were pregnant, had severe valvular disease or if they had known malig- Impact of Chronotropic Effect of Cilostazol After Acute Myocardial Infarction Insights From Change in Left Ventricular Volume and FunctionSang Hak Lee, MD**; Seung-Hyuk Choi, MD* , **; Seonghoon Choi, MD; Jae-Hun Jung, MD; Namho Lee, MD; Young-Jin Choi, MD; Dae-Gyun Park, MD; Kyung-Soon Hong, MD; Kyoo-Rok Han, MD; Dong-Jin Oh, MD; Chong-Yun Rhim, MD Backgound Cilostazol, a phosphodiesterase inhibitor, is an antiplatelet agent with positive chronotropic effect, the impact of which on left ventricular (LV) volume and function in acute myocardial infarction (AMI) was evaluated in the present study. Methods and ResultsIn 56 patients with AMI ...

Impact of Cilostazol on Left Ventricular Geometry and Function: Assessment by Tissue Doppler Imaging and Two-Dimensional Speckle-Tracking Echocardiography

“…On the other hand, the elevation of intracellular cAMP results in increasing cardiac contractility. Therefore, Cilostazol administration often produces a positive inotropic and chronotropic effect 14–19 . However, the influence of cilostazol on left ventricular (LV) function by echocardiographic data has not been reported precisely.…”

“…Therefore, Cilostazol administration often produces a positive inotropic and chronotropic effect. [14][15][16][17][18][19] However, the influence of cilostazol on left ventricular (LV) function by echocardiographic data has not been reported precisely. The purpose of this study was to assess the influence of cilostazol on LV function using conventional echocardiography, tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE).…”

Effect of Cilostazol on In-Stent Neointimal Hyperplasia After Coronary Artery Stenting A Quantitative Coronary Angiography and Volumetric Intravascular Ultrasound Study

“…reactions. 18,24,25 The exact mechanism by which triple antiplatelet therapy results in reduced neointimal tissue proliferation remains unclear. Cilostazol decreases the activity of phosphodiesterase type III, leading to the accumulation of cyclic adenosine monophosphate.…”

Intensive Pharmacologic Treatment in Patients With Acute Non ST-Segment Elevation Myocardial Infarction Who Did Not Undergo Percutaneous Coronary Intervention

“…In addition, cilostazol, a phosphodiesterase inhibitor and an antiplatelet agent with a positive chronotropic effect, was used, with an impact on left ventricular volume and function in acute MI. 25 Also nicorandil, which has a myocardial protective effect during PCI in patients with ACS because of its ischemic preconditioning effect. 26 Third, previous trials evaluated only inhospital outcomes, whereas we evaluated not only in-hospital outcomes, but also MACE during a 1-month clinical follow-up.…”