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Nicorandil improves myocardial function by regulating plasma nitric oxide and endothelin-1 in coronary slow flow
Zuoyuan Chen1, Xiuhua Chen, Shan Li
1Departments of aCardiology bCardiac Ultrasound, The Affiliated Hospital of Qingdao University cDepartment of Internal Medicine, Qingdao Commercial Hospital dDepartment of Cardiology, Qingdao Fifth People's Hospital, Qingdao eDepartment of Cardiology, Dezhou People's Hospital, Dezhou, Shandong, China.
Insights
Nicorandil treatment improved left ventricular function and reduced chest pain in patients with coronary slow flow (CSF) by increasing nitric oxide (NO) and decreasing endothelin-1 (ET-1). This highlights nicorandil as a potential therapy for CSF.
Area of Science:
- Cardiology
- Vascular Biology
- Pharmacology
Background:
- Coronary slow flow (CSF) is a microvascular disorder with unclear causes and treatments.
- Left ventricular (LV) function in CSF patients requires further evaluation.
- Investigating therapeutic options for CSF is crucial.
Purpose of the Study:
- To assess global and regional LV function in patients with CSF.
- To evaluate the efficacy of nicorandil in treating CSF.
- To explore the impact of nicorandil on nitric oxide (NO) and endothelin-1 (ET-1) levels.
Main Methods:
- Echocardiography (Doppler and speckle tracking) assessed LV function in 36 CSF patients and 20 controls.
- Plasma levels of NO and ET-1 were measured.
- Patients received nicorandil (15 mg/day) for 90 days, with pre- and post-treatment assessments.
Main Results:
- CSF patients showed lower E, E/A ratio, and NO levels, and higher A and ET-1 levels compared to controls.
- LV longitudinal strain rate was significantly reduced in CSF patients.
- Nicorandil treatment improved LV function markers (E, E/A, longitudinal strain rate), increased NO, decreased ET-1, and relieved chest pain in 75% of patients.
Conclusions:
- Nicorandil may alleviate chest pain and improve impaired LV function in CSF.
- The mechanism may involve increasing NO and reducing ET-1.
- Nicorandil shows promise as a therapeutic agent for coronary slow flow.
Background:
Coronary slow flow (CSF) is a special coronary microvascular disorder. The pathogenesis and effective therapeutics of CSF remain unclear. This study aimed to evaluate the global and regional functions of the left ventricle (LV) and investigate the efficacy of nicorandil in patients with CSF.
Patients And Methods:
Thirty-six patients with CSF in the left anterior descending (LAD) branch and 20 patients with normal coronary arteries were included. Global and regional functions of the LV supplied by LAD were measured using conventional Doppler echocardiography and two-dimensional speckle tracking echocardiography, respectively, within 24 h after coronary angiography. Concentrations of plasma nitric oxide (NO) and endothelin-1 (ET-1) were detected using colorimetry and radioimmunoassay, respectively. The function of the LV and the levels of NO and ET-1 were also investigated before and 90 days after treatment with 15 mg/day of nicorandil.
Results:
Compared with the control group, the early diastolic peak velocity (E), E/A ratio, and plasma NO levels were lower, whereas the late diastolic peak flow velocity (A) and plasma ET-1 levels were significantly higher in the CSF group (P<0.05). The longitudinal strain rate peak of the LV was reduced significantly in CSF patients (P<0.001). After treatment, 75% (27/36) of CSF patients were free of chest pain. The values of E peak, E/A ratio, longitudinal strain rate peak, and plasma NO level were increased (P<0.001), whereas the ET-1 level was decreased in CSF patients (P<0.001).
Conclusion:
Nicorandil may improve chest pain symptoms and the impaired function of the LV, possibly by increasing plasma NO and reducing ET-1 in CSF.
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