Summary
The effect of nicorandil on myocardial perfusion in ischaemic heart disease has been studied using exercise-load Tl-201 myocardial SPECT (Ex-SPECT). Ex-SPECT was carried out in 12 patients with previous myocardial infarction (OMI) and 9 with angina pectoris (AP) before and after administration of nicorandil 15 mg/day, for three or more weeks; % Tl uptake and the washout rate in infarcted or ischaemic areas were calculated from short axial images using the Bull's eye method.
In the OMI group, % Tl uptake and washout rates in the infarction areas improved significantly from 52.4% and 0.25 before nicorandil to 60.4% and 0.38 after it. In the AP group, too, % Tl uptake and washout rates showed a significant improvement from 56.9% and 0.10 before to 69.1% and 0.33 after administration. Six subjects who had not received the drug, and who showed negative washout rates, had high improvement rates when nicorandil was administered, suggesting that the drug could increase myocardial perfusion during exercise loading as well as suppressing coronary spasm.
Ex-SPECT was done in 4 subjects before and after nicorandil and after subsequent surgical treatment (PTCA or CABG) and the effects of the two therapies were compared. The washout rate was improved from 0.01 to 0.34 by administration of nicorandil, and a notable increase in coronary artery blood flow was achieved compared to the level after surgical treatment, i.e. 0.50.
It was concluded that, normal dosages of nicorandil have a powerful direct effect of dilating the coronary arteries without any influence on preload or afterload.
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References
Uchida Y, Yoshimoto N, Murao S (1978) Effect of 2-nicotinamidoethyl nitrate on coronary circulation. Jpn Heart J 19: 112–124
Nakagawa Y, Takede K, Katano Y, Tsukada T, Kitagawa T, Otorii T, Imai S (1979) Effects of 2-nicotinamidoethyl nitrate on the cardiovascular system. Jpn Heart J 20: 881–895
Taira N, Satoh K, Yanagisawa T, Iwai T, Hiwatari M (1979) Pharmacological profile of a new coronary vasodilator drug, 2-nicotinamidoethyl nitrate (SG-75). Clin Exp Pharmacol Physiol 6: 301–316
Kato K, Asanoi H, Wakabayashi C, Hosoda S, Shiina A, Hosono K, Kurita A, Seki K, Ishida K, Kuroiwa A, Fukumoto A (1987) Effect of Nicorandil on exercise performance in patients with effect angina: a multicenter trial using a treadmill exercise test. J Cardiovasc Pharmacol 10 [Suppl 8]: S98-S103
Kishida H, Murao S (1987) Effect of a new coronary vasodilator, nicorandil, on variant angina pectoris. Clin Pharmacol Ther 42: 166–174
Ohnishi M, Maeda K, Fukuzaki T (1987) Antianginal mechanism of nicorandil: study on exercise invasive hemodynamics and thallium-201 myocardial perfusion images. J Jap Coll Angiol 27: 191–195
Holmn BL, Hill TC, Wynne J, Lovett RD, Zimmerman RE, Smith EM (1979) Single-photon transaxial emission computed tomography of the heart in normal subjects and in patients with infarction. J Nucl Med 20: 736–740
Garcia EV, Train KV, Maddahi J, Prigent F, Friedman J, Areeda J, Waxman A, Berman DS (1985) Quantification of rotational thallium-201 myocardial tomography. J Nucl Med 26: 17–26
Belz GG, Matthews J, Heinrich J, Wagner G (1984) Controlled comparison of the pharmacodynamic effects of nicorandil (SG-75) and isosorbide dinitrate in man. Eur J Clin Pharmacol 26: 681–685
Hayata N, Araki H, Nakamura M (1986) Effects of nicorandil on exercise tolerance in patients with stable effort angina: a double-blind study. Am Heart J 112: 1245–1250
Strauss HW, Harrison K, Langan JK, Lebowitz E, Pitt B (1975) Thallium-201 for myocardial imaging, relation of thallium-201 to regional myocardial perfusion. Circulation 51: 641–645
Pohost GM, Zir LM, Moore RH, McKusick KA, Guinly TE, BEller GA (1977) Differentiation of transiently ischemic from infarcted myocardium by serial imaging after a single dose of thallium-201. Circulation 55: 294–302
Melin JA, Becker LC (1986) Quantitative relationship between global left ventricular thallium uptake and blood flow: effects of propranolol, quabain, dipyridamole, and coronary artery occlusion. J Nucl Med 27: 641–652
Homma S, Gilliand Y, Guiney TE, Strauss HW, Boucher CA (1987) Safety of intravenous dipyridamole for stress testing with thallium imaging. Am J cardiol 59: 152–154
Aizawa T, Ogasahara K, Kato K (1987) Effects of nicorandil on coronary circulation in patients with ischemic heart disease: comparison with nitroglycerin. J Cardiovasc Pharmacol 10 [Suppl 8]: S123-S129
Lamping KA, Warltier DC, Hardman HF, Gross GJ (1984) Effects of nicorandil. A new antianginal agent, and nifedipine on collateral blood flow in a new antianginal agent, and nifedipine on collateral blood flow in a chronic coronary occlusion model. J Pharmacol Exp Thr 229: 359–363
Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Kato M, Tanaka S, Akiyama F (1978) Pathogenesis and treatment of angina pectoris at rest as seen from its response to various drugs. Jpn Circ J 42: 1–10
Arakawa K, Fujino M, Abe K, Mikasa A, Baba K, Hattori N, Sakai T, Nobuyoshi M, Saeki Y, Haku Y (1982) Clinical experience of nicorandil (SG-75) on angina pectoris (in Japanese). Rinsyo to Kenkyu 59: 1287–1295
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Yamazaki, J., Ohsawa, H., Uchi, T. et al. Study of the efficacy of nicorandil in patients with ischaemic heart disease using Exercise-Tl-201 myocardial tomography. Eur J Clin Pharmacol 44, 211–217 (1993). https://doi.org/10.1007/BF00271360
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DOI: https://doi.org/10.1007/BF00271360