Nicorandil Infusion Leads to Good Recovery From Ischemia of Left Ventricular Regional Work in Comparison With Nitroglycerin.

Abstract

icorandil (NR), a nicotinamide-nitrate ester [N-(2-hydroxyethyl)-nicotinamide nitrate)], is an antianginal drug with 2 characteristic functions: the conventional nitrate effect mediated by cyclic guanosine monophosphate (cGMP), and an independent ATP-dependent potassium channel-opening effect. [1][2][3][4][5] Nitrates induce arterial and venous dilatation of the epicardial coronary vessels, including the stenotic segment, by increasing cGMP within the vascular smooth muscle cells. 6-9 The potassium-channel opening effect is believed to reduce calcium influx secondary to action potential shortening and thus prevent or attenuate membrane depolarization, which in turn may lead to reduced ATP consumption during ischemia. 10 The unique cardioprotective function of NR suggests that it may have advantages over other available antianginal agents.Percutaneous transluminal coronary angioplasty (PTCA) is an important interventional therapy widely used to treat patients with coronary artery disease. The myocardial conditions induced by the PTCA procedure are an ideal human model of transient myocardial ischemia that provides an appropriate opportunity to study the effect of antianginal agents.Sugawara MethodsPatients Twenty-two patients (15 men, 7 women; age (mean ± SD), 63±8 years) with stable angina pectoris were recruited. The frequency of chest pain was less than twice per week. They were scheduled for PTCA to a significant stenosis in the proximal left anterior descending artery (LAD). All patients had single-vessel coronary artery disease without angiographic evidence of collateral circulation and with normal wall motion assessed by both 2-dimensional (D) echocardiography and left ventriculography. Patients with unstable angina, recent or previous myocardial infarction, arrhythmia (atrial fibrillation etc), valvular diseases, or other cardiac disease were excluded. Moreover, patients with systemic disease (hypertension, diabetes mellitus etc), which would influence cardiac function, were also excluded. All patients underwent exercise 201 Tl myocardial scintigraphy, which confirmed that they had myocardial ischemia in the LAD region. No patients received -adrenergic blocking agents, calcium channel blocking agents, or other cardiovascular drugs within 48 h of the study. We explained the content of the study to all participants and they gave written informed consent. Nicorandil is an antianginal drug that exerts both a conventional nitrate effect and an independent ATP-dependent potassium channel-opening effect. The present study examined the effects of nicorandil on left ventricular regional work (RW) during coronary angioplasty in 22 patients with angina pectoris who were scheduled for angioplasty to the left anterior descending artery. The patients were randomly assigned to receive either nitroglycerin (group NG, n=12, 0.5 g· kg -1 · min -1 ) or nicorandil (group NR, n=10, 1.5 g· kg -1 · min -1 ). Inflation was performed for 60 s and the data were collected every 10 s. The RW was derived from the relation between me...

Nicorandil reduces the incidence of minor cardiac marker elevation after coronary stenting

“…A clinical study [20] found that infusion of 0.5 Ag/kg/min nicorandil enhanced regional ventricular wall motion recovery during coronary angioplasty. Other studies of the effects of a similar dose of nicorandil on coronary angioplasty found maximal precon- ditioning effects of nicorandil during coronary angioplasty without collateral flow changes, as judged by ST-segment elevation and coronary artery pressure measurements in electrocardiograms [21,22].…”

Comparison of Nitrite Compounds and Carperitide for Initial Treatment of Acute Decompensated Heart Failure

“…Similarly, the NC dose in this study was conventional, based on several Japanese studies that used 0.50-0.55 μg/kg/minute of NC. 19,20) Suwa, et al demonstrated that the efficacy of carperitide in reducing mortality and subjective symptoms was not dosedependent. 7) However, the effects of carperitide on hemodynamics were not investigated in their study.…”

Delayed recovery of left ventricular regional work after coronary angioplasty in patients with opposite wall old myocardial infarction

“…[1][2][3] In many of these patients, the regional work of the nonischemic area gradually increased during balloon inflation.…”

“…Recently, sequential changes in LV regional function during PTCA have been reported in patients with normal LV function. [1][2][3] However, no prior studies have assessed these changes during PTCA in patients having a reduced LV function. Regional LV function was previously evaluated by calculating regional work using the relationship between mean wall stress and strain (the natural logarithm of the reciprocal of wall thickness).…”

“…Regional LV function was previously evaluated by calculating regional work using the relationship between mean wall stress and strain (the natural logarithm of the reciprocal of wall thickness). [1][2][3][4][5][6][7][8][9][10][11][12][13] In this study, we examined the sequential changes of LV regional work from the beginning of balloon inflation to just after balloon deflation of the left anterior descending coronary artery (LAD) in patients with or without posterior OMI, and finally clarified the characteristics of the sequential changes of LV regional work during PTCA in patients having a reduced LV function.…”