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The Anti-Inflammatory and Antiapoptotic Effects of Nicorandil in Antisepsis Cardiomyopathy. Cardiovasc Ther 2021; 2021:5822920. [PMID: 34950238 PMCID: PMC8668340 DOI: 10.1155/2021/5822920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To observe the effect of nicorandil on septic rats and explore the possible mechanism of its myocardial protection, so as to provide theoretical basis for the treatment of septic cardiomyopathy. Methods Sixty male clean SD rats were selected as the research objects and randomly divided into 3 groups by random number method: sham operation group (sham group), cecal ligation and perforation group (CLP group), nicorandil treatment group (nicorandil+CLP group). After the operation, the nicorandil group was pumped with nicorandil diluent 1 ml/h (2 mg/kg/h) with a micropump for 6 hours. The sham group and CLP group were pumped with the same amount of normal saline 1 ml/h for a total of 6 hours. After 24 hours, the survival of the rats in each group was observed. The expression of troponin I (cTnI), tumor necrosis factor α (TNF-α), and interleukin-1β (IL-1β) in the serum was detected. Then, the ventricle was harvested for the observation of the pathological changes of myocardium. Quantitative real-time polymerase chain reaction and immunostaining were used to detect myocardial tissue apoptosis, and Western blot methods were used to detect protein expression changes in nuclear factor-κB (NF-κB) pathways. Results 24 hours after operation, the survival rate of the rats in the CLP group was 60%. There was a large amount of necrosis of myocardial cells and inflammatory cell infiltration. The survival rate of rats in the nicorandil+CLP group was 75%. Compared with the CLP group, the necrosis of myocardial cells was reduced, and there was still a small amount of inflammatory cell infiltration. In the CLP group, myocardial inflammation and apoptosis were significant, and NF-κB pathway was activated. On the contrary, the NF-κB pathway in the nicorandil+CLP group was inhibited, and the expression of inflammatory factors and apoptosis factors was inhibited. Conclusion Nicorandil can reduce the release of inflammatory factors in septic rats, improve the inflammatory response, reduce myocardial damage, and play a myocardial protective effect. Its mechanism may be related to the inhibition of the activation of NF-κB signaling pathway.
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The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir J Med Sci 2019; 189:119-131. [DOI: 10.1007/s11845-019-02034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022]
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The Relationship between Compound Danshen Dripping Pills with Isosorbide Mononitrate in the Treatment of Elderly Patients with Unstable Angina Pectoris. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:3429151. [PMID: 30108652 PMCID: PMC6077409 DOI: 10.1155/2018/3429151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/10/2018] [Indexed: 12/11/2022]
Abstract
Objective To evaluate the clinical efficacy and safety of Compound Danshen Dripping Pill (CDDP) and Isosorbide Mononitrate (ISMN) in the treatment of unstable angina pectoris (UAP) in the elderly. Materials and Methods CNKI, Wanfang, VIP, CBM, and PubMed databases were searched for appropriate articles without language limitations on keywords. RevMan 5.3 software was used to perform the meta-analysis. Results This analysis compared CDDP with ISMN of 21 randomized controlled trials (RCTs) that involved a total of 2356 patients with UAP. When the treatment lasted for four weeks, the clinical effective rate was OR = 3.97, 95% CI = 2.97, 5.30, and P < 0.00001, the ECG efficiency was OR = 3.43, 95% CI = 2.13, 5.53, and P < 0.00001, and incidence of adverse reactions was OR = 0.73, 95% CI = 0.52, 1.04, and P = 0.08 > 0.05. When the treatment lasted for eight weeks, clinical efficiency rate was OR = 4.22, 95% CI = 2.37, 3.79, and P < 0.00001, incidence of adverse reactions was OR = 0.58, 95% CI = 0.26, 1.27, and P = 0.17 > 0.05, whole blood low-cut blood viscosity was SMD = -0.61 and 95% CI -1.60, 0.38, whole blood high-cut blood viscosity was SMD = -0.38 and 95% CI -0.97, 0.21, and blood cells specific volume was SMD = -0.80 and 95% CI -2.61, 1.01. Conclusion Based on this meta-analysis, the CDDP was superior to ISMN with UAP in the elderly. However, there is still a need to further verify the clinical efficacy and safety of CDDP with more strictly designed RCTs with large sample and multiple centers in the future.
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Zhao F, Chaugai S, Chen P, Wang Y, Wang DW. Effect of nicorandil in patients with heart failure: a systematic review and meta-analysis. Cardiovasc Ther 2015; 32:283-96. [PMID: 25319832 DOI: 10.1111/1755-5922.12097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE It is unclear whether nicorandil, a metabolic therapeutic drug, can be applied clinically to therapy of heart failure (HF). This meta-analysis evaluated therapeutic effects of nicorandil on HF patients. EXPERIMENTAL APPROACH We performed a systematic review and meta-analysis of published studies evaluating effect of nicorandil on HF patients. Studies were stratified according to controlled versus uncontrolled designs and analyzed using random-effects meta-analysis models. KEY RESULTS We identified a total of 20 studies with a total of 1222 patients. In five randomized controlled studies, nicorandil treatment resulted in reduction in all-cause mortality and hospitalization for cardiac causes (HR: 0.35, P < 0.001) and improved cardiac pump function (SMD: 0.31, P = 0.02). In 15 observational studies, nicorandil therapy increases cardiac pump function (SMD: 0.75, P < 0.001), improves NYHA functional class (WMD: -1.33, P < 0.001), decreases PCWP (WMD: -6.86 mm Hg, P < 0.001), and pulmonary arterial pressure (SMD: -0.84, P < 0.001). CONCLUSIONS AND IMPLICATIONS The use of nicorandil in HF patients exerts substantial beneficial effects, suggesting that it may be an additional therapeutic agent for HF.
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Affiliation(s)
- Fujie Zhao
- Departments of Internal Medicine and Institute of Hypertension, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Nishimura M, Okamoto Y, Takatani T, Sato N, Nishida M, Hashimoto T, Yamazaki S, Kobayashi H, Ono T. Improvement of myocardial fatty acid metabolism by oral nicorandil in hemodialysis patients without coronary artery disease. J Nephrol 2014; 28:227-34. [PMID: 25070153 DOI: 10.1007/s40620-014-0125-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism assessed by single-photon emission computed tomography (SPECT) using (123)I-β-methyliodophenyl pentadecanoic acid (BMIPP) in hemodialysis patients without obstructive coronary artery disease (CAD). METHODS This study was based on a cohort study of 155 hemodialysis patients with angiographic absence of obstructive CAD, with analysis performed in 100 propensity-matched patients (54 men and 46 women, 64 ± 10 years); 50 with oral administration of nicorandil (15 mg/d, nicorandil group) and 50 without (control). BMIPP SPECT was performed every year after angiography. Uptake on SPECT was graded in 17 segments on a five-point scale (0 normal, 4 absent) and assessed as BMIPP summed scores (SS). RESULTS Over a mean follow-up period of 5.3 ± 1.9 years, we observed 25 cardiac deaths among 100 propensity-matched patients. Myocardial uptake of BMIPP in SPECT improved in the nicorandil group compared with the control group from 2 years of administration. In Kaplan-Meier survival analyses, free survival rate from cardiac death was higher in patients with a BMIPP SS improvement rate of ≥20% compared to those with ≥0% <20% or with <0% BMIPP SS improvement rate. At multiple logistic analysis, a ≥20% BMIPP SS improvement rate was positively associated with serum albumin concentration and oral nicorandil. CONCLUSIONS Long-term oral nicorandil may inhibit cardiac death by improving myocardial fatty acid metabolism in hemodialysis patients without obstructive CAD.
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Affiliation(s)
- Masato Nishimura
- Cardiovascular Division, Toujinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan,
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Nishimura M, Okamoto Y, Tokoro T, Sato N, Nishida M, Hashimoto T, Kobayashi H, Yamazaki S, Okino K, Iwamoto N, Takahashi H, Ono T. Clinical potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention in hemodialysis patients. Nephron Clin Pract 2014; 126:24-32. [PMID: 24434794 DOI: 10.1159/000357579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The assessment of myocardial fatty acid metabolism impairment by single-photon emission computed tomography (SPECT) using (123)I-β-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the risk of cardiac death in hemodialysis patients. We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention (PCI) in this population. METHODS We evaluated 128 hemodialysis patients who had obtained coronary revascularization by PCI (90 men and 38 women, 66 ± 9 years). Participants for the analysis were randomly assigned to either the nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed every year after coronary revascularization by PCI. Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores (SS). RESULTS The incidence of cardiac death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in the control group (21/65, 32.3%) during a mean follow-up of 2.7 ± 1.4 years. BMIPP SS reduction rates improved in the nicorandil group compared with the control group from 3 years of administration. In Kaplan-Meier analyses, free survival rate of cardiac death was higher in patients with a ≥20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS reduction rate (p = 0.0001). In multiple logistic analysis, oral administration of nicorandil was associated with ≥20% reduction rates of BMIPP SS (odds ratio 2.823, p = 0.011). CONCLUSION Long-term oral administration of nicorandil may improve impaired myocardial fatty acid metabolism after coronary revascularization by PCI in hemodialysis patients.
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Nishimura M, Sakoda C, Murakawa M, Okamoto Y, Tokoro T, Sato N, Nishida M, Hashimoto T, Kobayashi H, Yamazaki S, Iwamoto N, Takahashi H, Ono T. Oral nicorandil for prevention of cardiac death in hemodialysis patients without obstructive coronary artery disease: a propensity-matched patient analysis. Nephron Clin Pract 2011; 119:c301-9. [PMID: 21934329 DOI: 10.1159/000329112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We examined the potential of oral administration of nicorandil for protecting against cardiac death in hemodialysis patients without obstructive coronary artery disease. METHODS This study was based on a cohort study of 155 hemodialysis patients with angiographic absence of obstructive coronary lesions, with analysis performed in 100 propensity-matched patients (54 men and 46 women, 64 ± 10 years), including 50 who received oral administration of nicorandil (15 mg/day, nicorandil group) and 50 who did not (control). The efficacy of nicorandil in preventing cardiac death was investigated. RESULTS Over a mean follow-up period of 5.3 ± 1.9 years, we observed 25 cardiac deaths among 100 propensity-matched patients, including 6 due to acute myocardial infarction, 11 due to heart failure, and 8 due to sudden cardiac death. The incidence of cardiac death was lower (p < 0.001) in the nicorandil group (4/50, 8%) than in the control (21/50, 42%). On multivariate Cox hazard analysis, cardiac death was inversely associated with oral nicorandil (hazard ratio, 0.123; p = 0.0002). On Kaplan-Meier analysis, cardiac death-free survival rates at 5 years were higher in the nicorandil group than in the control group (91.4 vs. 66.4%). CONCLUSION Oral nicorandil may inhibit cardiac death of hemodialysis patients without obstructive coronary artery disease.
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Affiliation(s)
- Masato Nishimura
- Cardiovascular Division, Toujinkai Hospital, Kansai Medical University, Osaka, Japan.
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Ishii H, Amano T, Matsubara T, Murohara T. Pharmacological prevention of peri-, and post-procedural myocardial injury in percutaneous coronary intervention. Curr Cardiol Rev 2011; 4:223-30. [PMID: 19936199 PMCID: PMC2780824 DOI: 10.2174/157340308785160598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 05/09/2008] [Accepted: 05/09/2008] [Indexed: 02/02/2023] Open
Abstract
In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Horinaka S, Yabe A, Yagi H, Ishimitsu T, Yamazaki T, Suzuki S, Kohro T, Nagai R, The JCAD Study Investigators. Effects of Nicorandil on Cardiovascular Events in Patients With Coronary Artery Disease in The Japanese Coronary Artery Disease (JCAD) Study. Circ J 2010; 74:503-9. [DOI: 10.1253/circj.cj-09-0649] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigeo Horinaka
- Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University
| | - Akihisa Yabe
- Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University
| | - Hiroshi Yagi
- Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University
| | - Toshihiko Ishimitsu
- Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University
| | - Tsutomu Yamazaki
- Department of Clinical Epidemiology and Systems, University of Tokyo
| | - Shinya Suzuki
- Department of Clinical Epidemiology and Systems, University of Tokyo
| | - Takahide Kohro
- Department of Translational Research for Healthcare and Clinical Science, University of Tokyo
| | - Ryozo Nagai
- Department of Cardiovascular Medicine Graduate School of Medicine, University of Tokyo
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Nishimura M, Tokoro T, Nishida M, Hashimoto T, Kobayashi H, Imai R, Yamazaki S, Okino K, Iwamoto N, Takahashi H, Ono T. Oral Nicorandil to Reduce Cardiac Death After Coronary Revascularization in Hemodialysis Patients: A Randomized Trial. Am J Kidney Dis 2009; 54:307-17. [DOI: 10.1053/j.ajkd.2009.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 03/31/2009] [Indexed: 11/11/2022]
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Yoshida S, Nakamura S, Sugiura T, Tsuka Y, Maeba H, Yuasa F, Senoo T, Takehana K, Baden M, Iwasaka T. Factors associated with myocardial salvage immediately after emergent percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. Ann Nucl Med 2009; 23:383-90. [DOI: 10.1007/s12149-009-0253-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 02/05/2009] [Indexed: 11/28/2022]
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Lee TM, Lin MS, Chang NC. Effect of pravastatin on sympathetic reinnervation in postinfarcted rats. Am J Physiol Heart Circ Physiol 2007; 293:H3617-26. [PMID: 17890424 DOI: 10.1152/ajpheart.00875.2007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We assessed whether pravastatin attenuates cardiac sympathetic reinnervation after myocardial infarction through the activation of ATP-sensitive K+(KATP) channels. Epidemiological studies have shown that men treated with statins appear to have a lower incidence of sudden death than men without statins. However, the specific factor for this has remained disappointingly elusive. Twenty-four hours after ligation of the anterior descending artery, male Wistar rats were randomized to groups treated with either vehicle, nicorandil (a specific mitochondrial KATPchannel agonist), pinacidil (a nonspecific KATPchannel agonist), pravastatin, glibenclamide (a KATPchannel blocker), or a combination of nicorandil and glibenclamide, pinacidil and glibenclamide, or pravastatin and glibenclamide for 4 wk. Myocardial norepinephrine levels revealed a significant elevation in vehicle-treated rats at the remote zone compared with sham-operated rats (2.54 ± 0.17 vs. 1.26 ± 0.36 μg/g protein, P < 0.0001), consistent with excessive sympathetic reinnervation after infarction. Immunohistochemical analysis for tyrosine hydroxylase, growth-associated factor 43, and neurofilament also confirmed the change of myocardial norepinephrine. This was paralleled by a significant upregulation of tyrosine hydroxylase protein expression and mRNA in vehicle-treated rats, which was reduced after the administration of either nicorandil, pinacidil, or pravastatin. Arrhythmic scores during programmed stimulation in vehicle-treated rats were significantly higher than those treated with pravastatin. In contrast, the beneficial effects of pravastatin were reversed by the addition of glibenclamide, implicating KATPchannels as the relevant target. The sympathetic reinnervation after infarction is modulated by the activation of KATPchannels. Chronic use of pravastatin after infarction, resulting in attenuated sympathetic reinnervation by the activation of KATPchannels, may modify the arrhythomogenic response to programmed electrical stimulation.
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Affiliation(s)
- Tsung-Ming Lee
- Cardiology Section, Department of Medicine, Taipei Medical University, 252 Wu-Hsing Street, Taipei, Taiwan
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Hatori T, Toyama T, Kasama S, Suguta M, Nakano A, Hasegawa A, Endo K, Kurabayashi M. 123I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after rotational atherectomy. Ann Nucl Med 2007; 21:137-44. [PMID: 17561584 DOI: 10.1007/s12149-006-0007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND During rotational atherectomy (RA), the coronary atherosclerotic plaque is largely pulverized into microdebris, which may cause serious hemodynamic instability owing to significant segmental left ventricular asynergy embolization of the distal microvasculature by atheromatous debris and associated vasospasm. OBJECTIVE To evaluate the usefulness of 123I-metaiodobenzylguanidine (123I-MIBG) in the examination of microvascular embolization after RA. METHODS AND RESULTS Nineteen patients with stable effort angina pectoris who had undergone RA were evaluated in this study. Left ventricular ejection fraction (LVEF) was determined by left ventriculography immediately before and after RA. The serum concentration of creatine phosphokinase (CPK), creatine phosphokinase-myocardial band (CPK-MB) isozyme, and cardiac troponin-T was determined after RA. 99mTc-methoxyiso-butylisonitrile (99mTc-MIBI) and 123I-MIBG scintigraphic examinations were also performed 1 day after RA. The regional defect score (RDS) was determined from 99mTc-MIBI scintigraphic findings, while early and delayed RDS, heart-to-mediastinum count ratios (H/M ratios), and washout rate (WR) were determined from 123I-MIBG scintigraphy. After RA, the left ventriculographic LVEF mildly decreased by <10% in ten patients (group A), but it decreased by >10% in the remaining nine patients (group B). There were no differences in baseline clinical characteristics between the two groups. The CPK, CPK-MB isozyme, troponin-T, RDS by 99mTc-MIBI, H/M ratios, and WR after RA were similar in the two groups. However, the RDSs determined from early and delayed 123I-MIBG in group A were significantly lower than those in group B (4.5 +/- 3.8 vs. 13.4 +/- 10.8, P < 0.05; 9.0 +/- 6.3 vs. 17.7 +/- 10.0, P < 0.05, respectively). Moreover, there were significant correlations between delta LVEF and troponin-T (r = 0.54, P < 0.05) and RDSs of early and delayed 123I-MIBG (r = 0.46, P < 0.05; r = 0.64, P < 0.05, respectively). CONCLUSIONS These findings suggest that 123I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after RA.
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Affiliation(s)
- Takashi Hatori
- Department of Medicine and Biological Science, Graduate School of Medical Sciences, Gunma University, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan.
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Abstract
(123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is one of only a few methods available for objective evaluation of cardiac sympathetic function at the clinical level. Disorders of cardiac sympathetic function play an important role in various heart diseases, and MIBG provides an abundance of useful information for the evaluation of severity, prognosis and therapeutic effects; this is particularly useful in cases of heart failure, ischaemic heart disease and arrhythmic disease. On the other hand, the quantitative indices for MIBG differ between institutions, and evidence has not been sufficiently well established for MIBG scintigraphy when compared with myocardial perfusion imaging in ischaemic heart diseases. In consideration of these difficulties, this review provides fundamental information regarding MIBG, its usefulness for various diseases and future difficulties.
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Affiliation(s)
- Shohei Yamashina
- Department of Cardiovasular Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
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Kashimoto S, Seki M, Ishiguro T, Yoshioka H, Nagata O, Nishimura K, Kikuchi T, Yamada T, Iwade M, Omi A, Honda O, Sakamoto A, Ogihara Y, Fujimoto K, Nakaigawa Y, Kato J, Watanabe A, Nomura M, Takeda J. Nicorandil decreases cardiac events during and after noncardiac surgery. J Clin Anesth 2007; 19:44-8. [PMID: 17321926 DOI: 10.1016/j.jclinane.2006.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 05/17/2006] [Accepted: 05/17/2006] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To assess whether nicorandil reduces the likelihood of cardiac events during and after intermediate risk surgery. DESIGN Multicenter study. SETTING 13 hospitals in Japan. PATIENTS Intermediate-risk patients were identified by the presence of risk factors such as angina, a history of myocardial infarction, heart failure, diabetes mellitus, and abnormal electrocardiography (ECG). INTERVENTIONS Nicorandil was given to these patients during the operation. MEASUREMENTS AND MAIN RESULTS Cardiac events during the operation and the following 5 days were monitored. The frequency of cardiac events in nicorandil-treated patients was compared with those in nontreated patients. Eighty-four patients received nicorandil during surgery and 237 patients received standard care. Cardiac events in the nicorandil-treated group occurred less frequently both during the operation (odds ratio, 0.15; 95% confidence interval, 0.03-0.76; P=0.02) and after it (odds ratio, 0.24; 95% confidence interval, 0.06-0.90; P=0.04). CONCLUSIONS Nicorandil reduces the frequency of cardiac events in patients undergoing noncardiac surgery, both during and after the operation.
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Affiliation(s)
- Satoshi Kashimoto
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Tamaho, Yamanashi 409-3898, and Department of Anesthesia, Cancer Institute Hospital, Tokyo, Japan.
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Abstract
BACKGROUND 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is one of only a few methods available for objective evaluation of cardiac sympathetic function at a clinical level. Disorders in cardiac sympathetic function play an important role in various heart diseases, and MIBG provides an abundance of useful information for evaluation of disease severity, prognosis, and therapeutic effects; this information is of particular value in patients with heart failure, ischemic heart diseases, or arrhythmic disorders. On the other hand, the quantitative indices for MIBG differ between institutions, and evidence has not been sufficiently well established for MIBG, compared with myocardial perfusion imaging, in ischemic heart diseases. REVIEW In view of these difficulties, this review provides fundamental information regarding MIBG, its usefulness for various diseases and future difficulties.
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Affiliation(s)
- Shohei Yamashina
- Department of Cardiovasular Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
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Ishii H, Toriyama T, Aoyama T, Takahashi H, Yamada S, Kasuga H, Ichimiya S, Kanashiro M, Mitsuhashi H, Maruyama S, Matsuo S, Naruse K, Matsubara T, Murohara T. Efficacy of oral nicorandil in patients with end-stage renal disease: A retrospective chart review after coronary angioplasty in japanese patients receiving hemodialysis. Clin Ther 2007; 29:110-22. [PMID: 17379051 DOI: 10.1016/j.clinthera.2007.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients receiving hemodialysis for end-stage renal disease (ESRD) are at high risk for death from ischemic heart disease (IHD). Nicorandil, a hybrid compound of adenosine triphosphate-sensitive potassium channel opener and nitric oxide donor, has been reported to improve the clinical prognosis of patients with IHD. OBJECTIVE This study sought to investigate the efficacy of oral nicorandil in reducing the risks for cardiovascular events (CVEs) and CVE-related death in patients receiving hemodialysis for ESRD after undergoing percutaneous coronary intervention (PCI) for angina pectoris. METHODS For this retrospective chart review, we used data from telephone interviews and medical charts from 3 hospitals in Japan. Data from patients aged <80 years who were receiving hemodialysis for ESRD and who had undergone successful PCI for angina between January 1999 and December 2004 were included in the analysis. Patients were stratified based on status of nicorandil treatment before PCI, as follows: patients receiving nicorandil 5 mg PO TID (the recommended dosage in Japan) for >1 month before PCI (nicorandil group) or those who did not receive nicorandil (control group). We investigated 6-year follow-up data on the primary end point, defined as CVEs (ie, unplanned hospital admission for worsening anginal status, or CVE-related death). The secondary end point was CVE-related death. After the data were initially analyzed, we performed a propensity-matched analysis to minimize selection bias. RESULTS Data from 356 patients were included in the study (235 men, 121 women; mean [SD] age, 69 [9] years; mean [SD] weight, 52.3 [9.1] kg; nicorandil group, 198 patients; control group, 158 patients). According to the estimated propensity scores, 107 patients from each group were matched. There were no differences between the 2 groups in the baseline characteristics. On propensity-matched patient analysis, the estimated rates of patients who were CVE-free at 6 years were 33.5% in the nicorandil group and 21.8% in the control group on Kaplan-Meier analysis (hazard ratio [HR] = 0.53; 95% CI, 0.36-0.78; P < 0.002), and the rates of 6-year survival (ie, patients who did not experience CVE-related death) were 92.7% in the nicorandil group and 85.8% in the control group (HR = 0.27; 95% CI, 0.07-0.89; P = 0.047). Cox multivariate analysis found that nico-randil treatment status was an independent predictor of CVEs (HR = 0.40; 95% CI, 0.18-0.91; P = 0.028) and CVE-related death (HR = 0.38; 95% CI, 0.14-0.78; P = 0.030). CONCLUSION Results obtained in this retrospective study suggest the potential efficacy of nicorandil treatment in improving clinical outcomes in patients with IHD receiving hemodialysis following PCI.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine and Nagoya University Hospital, Nagoya, Japan.
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