Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure

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FIGURE 1.
Kaplan–Meier curve in reference to MACE stratified by MBR-IR value y-axis represents cumulative event-free rate (log-rank test, P < 0.001).
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FIGURE 2.
A 77-y-old man with acute ischemic heart failure in high–MBR-IR group. Rest myocardial perfusion SPECT images show anteroseptal–apical and distal inferior perfusion defects, and perfusion improvement is observed for anteroseptal wall in nicorandil-stress images, excluding central area of previous myocardial infarction site. MBR-IR is relatively high for an AIHF patient, with a value of 1.48. This patient remained MACE-free for entire 5-y follow-up period.
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FIGURE 3.
A 69-y-old woman with acute ischemic heart failure in low–MBR-IR group. Nicorandil stress and rest myocardial perfusion SPECT images show anteroseptal–apical perfusion defects, and perfusion improvement is observed only in marginal zone of previous myocardial infarction site in nicorandil-stress images. MBR-IR is low, with a value of 1.09. This patient was hospitalized due to deterioration of heart failure 189 d after initial onset.

TABLE 1

Patient Characteristics

NYHA = New York Heart Association; BNP = brain natriuretic peptide; MPI = myocardial perfusion imaging; MI = myocardial infarction; VD = vessel disease.
Categorical data are expressed as numbers, followed by percentages in parentheses, unless otherwise indicated; continuous data are expressed as mean ± SD or median (25th–75th).

TABLE 2

Cardiovascular Parameter Variations Between Nicorandil-Stress and Rest Conditions

TABLE 3

Comparison of Clinical Profiles Between High– and Low–MBR-IR Groups

Characteristic	High MBR-IR (n = 11 [50%])	Low MBR-IR (n = 11 [50%])	P
Age (y)	75 ± 9	65 ± 13	0.046
Male	7 (64%)	9 (82%)	0.635
NYHA class	0/0/2/9	0/2/0/9	0.883
BNP (pg/mL)	534 (189–965)	513 (412–704)	0.844
Hypertension	10 (91%)	11 (100%)	1.000
Dyslipidemia	6 (55%)	9 (82%)	0.361
Diabetes mellitus	5 (45%)	8 (73%)	0.387
Previous myocardial infarction	10 (91%)	10 (91%)	1.000
SSS	17 (15–24)	25 (23–28)	0.139
SRS	19 (16–28)	27 (24–29)	0.144
Rest LVEF (%)	38 (32–53)	31 (30–38)	0.216
Rest LVEDV (mL)	136 (90–165)	186 (156–201)	0.111
Rest LVESV (mL)	83 (43–116)	118 (103–140)	0.102
Nicorandil-stress MBR	29.49 (26.57–37.44)	26.70 (16.96–31.93)	0.151
Rest MBR	18.62 (16.62–26.80)	25.39 (16.17–30.71)	0.507
MBR-IR	1.55 (1.34–1.61)	1.08 (1.02–1.10)	<0.001
MBR-IR in infarcted region	1.06 (1.00–1.06)	0.98 (0.97–1.00)	0.149
MBR-IR in ischemic region	1.57 (1.41–1.74)	1.18 (1.16–1.22)	0.002

NYHA = New York Heart Association; BNP = brain natriuretic peptide; SSS = summed stress score; SRS = summed rest score.
Categorical data are expressed as counts (%), and continuous data are expressed as mean ± SD or median (25th–75th).

TABLE 4

Comparison of Clinical Profiles of All Patients Who Did and Did Not Experience MACE

Characteristic	MACE (n = 12 [55%])	No MACE (n = 10 [45%])	P
Age (y)	70 ± 10	71 ± 14	0.950
Male	9 (75%)	7 (70%)	1.000
NYHA class	0/0/1/11	0/2/1/7	0.185
BNP (pg/mL)	664 (420–794)	408 (184–687)	0.277
Hypertension	12 (100%)	9 (90%)	0.455
Dyslipidemia	9 (75%)	6 (60%)	0.652
Diabetes mellitus	7 (58%)	6 (60%)	1.000
Previous myocardial infarction	12 (100%)	8 (80%)	0.195
SSS	25 (21–28)	20 (15–25)	0.209
SRS	27 (23–29)	22 (15–29)	0.427
Low MBR-IR	10 (83%)	1 (10%)	0.002
Rest LVEF (%)	31(30–39)	38 (31–53)	0.477
Treatments after myocardial perfusion imaging
PCI	3 (25%)	1 (10%)	0.594
CABG	1 (8%)	1 (10%)	1.000
Nicorandil	7 (58%)	5 (50%)	1.000
ARB	11 (92%)	6 (60%)	0.135
β-blocker	10 (83%)	9 (90%)	1.000
Statin	10 (83%)	6 (60%)	0.348
Pacemaker implantation	2 (17%)	0 (0%)	0.481
ICD implantation	1 (8%)	0 (0%)	1.000

NYHA = New York Heart Association; BNP = brain natriuretic peptide; SSS = summed stress score; SRS = summed rest score; PCI = percutaneous coronary intervention; CABG = coronary artery bypass grafting; ARB = angiotensin receptor blocker; ICD = implantable cardioverter-defibrillator.
Categorical data are expressed as counts (%), and continuous data are expressed as mean ± SD or median (25th–75th).

TABLE 5

Univariate and Multivariate Cox Regression Analysis for Occurrence of MACE

	Univariate			Multivariate
Characteristic	Hazard ratio	95% confidence interval	P	Hazard ratio	95% confidence interval	P
Age	0.999	0.967–1.032	0.945
NYHA class IV	1.589	0.536–4.312	0.404
BNP	1.000	0.999–1.001	0.160	1.001	0.999–1.002	0.086
Hypertension	1.833	0.246–13.677	0.554
Dyslipidemia	1.259	0.512–3.097	0.615
Diabetes mellitus	0.947	0.404–2.220	0.901
Previous myocardial infarction	1.920	0.446–8.261	0.381
SSS	1.009	0.966–1.055	0.683
SRS	1.003	0.964–1.044	0.866
Low MBR-IR	3.640	1.456–9.103	0.006	3.913	1.552–9.868	0.004
Rest LVEF	0.992	0.964–1.020	0.576
Treatment after MPI
PCI	1.601	0.538–4.761	0.398
CABG	0.771	0.179–3.309	0.726
Nicorandil	1.091	0.471–2.529	0.839
ARB	1.639	0.598–4.495	0.337
β-blocker	1.013	0.298–3.451	0.983
Statin	1.359	0.528–3.501	0.525

NYHA = New York Heart Association; BNP = brain natriuretic peptide; SSS = summed stress score; SRS = summed rest score; MPI = myocardial perfusion imaging; PCI = percutaneous coronary intervention; CABG = coronary artery bypass grafting; ARB = angiotensin receptor blocker; ICD = implantable cardioverter-defibrillator.