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Clinical Investigation |
1 Department of Cardiovascular Medicine, Gunma University School of Medicine, Maebashi, Japan; and 2 Cardiovascular Hospital of Central Japan, Gunma, Japan
Correspondence: For correspondence or reprints contact: Shu Kasama, MD, Department of Cardiovascular Medicine, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan. E-mail: s-kasama{at}bay.wind.ne.jp
Nicorandil, an adenosine triphosphate–sensitive potassium channel opener, reduces plasma norepinephrine concentration in patients with ischemic heart disease. However, long-term effects on cardiac sympathetic nerve activity (CSNA) as evaluated by 123I-metaiodobenzylguanidine (MIBG) scintigraphy have not been determined for patients with acute myocardial infarction (AMI). Methods: We studied 40 patients with their first AMI who were treated with intravenous nicorandil before and after primary coronary angioplasty. After suspension of the initial intravenous nicorandil treatment, 20 patients were randomized to receive oral nicorandil (15 mg/d) (group A) and the other 20 patients received a placebo (group B). All patients were also treated with an angiotensin-converting enzyme (ACE) inhibitor or ß-blockers. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from 123I-MIBG scintigraphy 3 wk and 6 mo after angioplasty. The left ventricular (LV) end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction (EF) were determined by contrast left ventriculography, whereas plasma procollagen type III amino-terminal peptide (PIIINP) concentrations were also measured at the same time points. Results: Three weeks after angioplasty, TDS, H/M ratios, WR, LVEDV, LVESV, and LVEF were similar in both groups. After 6 mo, all of these parameters had improved in both groups. However, the extent of change in TDS was –9 ± 6 in group A and –5 ± 6 in group B (P < 0.05), whereas that in the H/M ratio was 0.15 ± 0.13 and 0.07 ± 0.11 (P < 0.05) and that in the WR was –12% ± 8% and –5% ± 11% (P < 0.05). The extent of change in LVEDV, LVESV, and LVEF in group A tended to exceed that in group B, but these changes were not statistically significant. We found significant correlations between the percent change in PIIINP and that of TDS from baseline to 6 mo in group A (r = 0.456, P < 0.05). Conclusion: Long-term nicorandil therapy can be more beneficial for CSNA and LV remodeling than short-term therapy in patients with AMI.
Key Words: 123I-metaiodobenzylguanidine • myocardial infarction • ion channels
COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.
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