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Effects of intravenous administration of nicorandil on cardiovascular hemodynamics and left ventricular function
H Kambara1, S Tamaki, Y Nakamura
1Department of Internal Medicine, Kyoto University Hospital, Japan.
Insights
Nicorandil, an antianginal drug, improved left ventricular function and reduced harmful hemodynamic changes during induced ischemia in patients with coronary artery disease.
Area of Science:
- Cardiology
- Pharmacology
- Cardiovascular Physiology
Background:
- Coronary artery disease (CAD) poses significant challenges in managing myocardial ischemia.
- Antianginal drugs are crucial for alleviating symptoms and improving cardiac function during ischemic events.
- Understanding the effects of specific drugs like nicorandil on ventricular responses to stress is vital.
Purpose of the Study:
- To investigate the effects of nicorandil on hemodynamic and regional wall motion during pacing-induced ischemia in CAD patients.
- To evaluate nicorandil's efficacy in mitigating the adverse effects of transient myocardial ischemia.
Main Methods:
- Eight patients with coronary artery disease underwent intravenous administration of nicorandil (50 µg/kg).
- Hemodynamic parameters and left ventricular function were assessed using left ventriculograms before and after pacing-induced ischemia, with and without nicorandil pretreatment.
- Regional wall motion was quantified by measuring radial axis shortening from the center of gravity.
Main Results:
- Nicorandil significantly reduced left ventricular end-diastolic pressure and left ventricular systolic volume index.
- Ejection fraction significantly increased following nicorandil administration.
- Nicorandil improved left ventricular wall motion, counteracting the dyskinesia induced by rapid right ventricular pacing.
Conclusions:
- Nicorandil demonstrates beneficial effects on ventricular contractile and hemodynamic responses during transient ischemia.
- The drug effectively improves left ventricular function and wall motion under pacing-induced stress in CAD patients.
- Nicorandil shows promise as a therapeutic agent for managing ischemia in coronary artery disease.
Abstract:
The effects of the intravenous administration of the antianginal drug, nicorandil, 50 micrograms/kg administered over 2 minutes, were investigated during pacing-induced ischemia in 8 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 gravity of the end-diastolic silhouette. Heart rate, left ventricular (LV) systolic pressure and end-diastolic volume index did not change in the immediate postpacing period with or without medication. LV end-diastolic pressure decreased with nicorandil, from 22.0 +/- 3.4 to 17.0 +/- 2.3 mm Hg (mean +/- standard error of the mean) (p less than 0.05), and LV systolic volume index, from 39.6 +/- 8.0 to 30.4 +/- 6.8 ml/m2 (p less than 0.05). Ejection fraction increased from 55.2 +/- 5.0 to 64.3 +/- 3.8% (p less than 0.05). Stroke index and cardiac index (calculated from heart rate and stroke index) did not change significantly. Rapid right ventricular pacing increased the extent and degree of dyskinesia of the left ventricle, but premedication with nicorandil improved the wall motion. Thus, nicorandil has salutary effects on ventricular contractile and hemodynamic responses to transient ischemia induced by pacing stress.