Beneficial effects of nicorandil on cardiovascular hemodynamics and left ventricular function

The effects of sublingual nicorandil (5 mg), an antianginal drug, were investigated in pacing-induced ischemia in 11 patients with coronary artery disease. Hemodynamic parameters were measured, and single-plane left ventriculograms were obtained in control and postpacing periods both before and after pretreatment with nicorandil. Regional wall motion of the left ventricle was assessed by measuring shortening of the radial axes originating from the center of the gravity of the end-diastolic silhouette. Heart rate, left ventricular (LV) systolic pressure, and end-diastolic volume index were not changed in immediate postpacing with or without medication. The LV end-diastolic pressure decreased from 22.0 +/- 1.8 (SEM) to 18.4 +/- 1.7 mm Hg (p less than 0.01) and LV systolic volume index from 48.5 +/- 7.1 to 37.4 +/- 7.7 ml/m2 (p less than 0.01). Ejection fraction increased from 42.2 +/- 3.7 to 56.7 +/- 3.7% (p less than 0.01), stroke index (SI) from 34.5 +/- 3.7 to 43.1 +/- 2.2 ml/beat/m2 (p less than 0.01), and cardiac index (calculated from heart rate and SI) from 2.49 +/- 0.30 to 3.09 +/- 0.19 L/min/m2 (p less than 0.01). With rapid right ventricular pacing, dyskinesis of the left ventricle increased in both area and degree, but was improved with premedication with nicorandil. Thus, nicorandil has salutary effects on ventricular contractile and hemodynamic responses to transient ischemia induced by pacing stress.