Inoue F, Hashimoto T, Fujimoto S, Uemura S, Kawamoto A, Dohi K
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Heart Vessels. 1998;13(5):229-36. doi: 10.1007/BF03257245.
We investigated the usefulness of the intracoronary administration of nicorandil (NIC) compared with that of papaverine (PAP) in the evaluation of coronary flow reserve (CFR) in 17 patients, including 10 patients with old myocardial infarction and 7 patients with angina pectoris. CFR was measured with a Doppler guidewire inserted into the distal site of the left anterior descending coronary artery during intracoronary administration of 10 mg PAP, and of 0.5 mg, 1.0 mg, 2.0 mg, and 3.0 mg NIC. We examined the changes in heart rate (HR), mean blood pressure (mBP), the total score of QTc interval on a 12-lead electrocardiogram (sigma QTc), and ST-T segment, before and after drug administration. CFR was significantly lower during administration of 0.5 mg (1.9 +/- 0.9) and 1.0 mg (2.2 +/- 0.9) NIC than during administration of PAP (2.6 +/- 1.1) (P < 0.01). There was no significant difference in the CFR during administration of 2.0 mg (2.6 +/- 1.0) or 3.0 mg (2.5 +/- 1.0) NIC and that observed during administration of PAP. The CFR during administration of PAP was significantly correlated with that during administration of 2.0 mg NIC (r2 = 0.72, P < 0.0001) and 3.0 mg NIC (r2 = 0.70, P < 0.0001). PAP, but not NIC, significantly altered the HR, mBP, and sigma QTc. Inverted T waves were observed in 14 patients, and elevation of the ST segment was observed in 4 patients during administration of PAP (including 1 patient with ventricular tachycardia). The administration of 0.5 mg to 2.0 mg NIC was not associated with ST-T segment changes, except in 1 patient, but inverted T waves were observed in 2 patients and depression of the ST segment was observed in 2 patients during administration of 3.0 mg NIC. Intracoronary administration of NIC is useful and safe for evaluating the CFR. The appropriate dose for measuring CFR is 2.0 mg nicorandil.
我们研究了在17例患者中，与罂粟碱（PAP）相比，冠状动脉内注射尼可地尔（NIC）在评估冠状动脉血流储备（CFR）方面的有效性，其中包括10例陈旧性心肌梗死患者和7例心绞痛患者。在冠状动脉内注射10 mg PAP以及0.5 mg、1.0 mg、2.0 mg和3.0 mg NIC期间，使用插入左前降支冠状动脉远端部位的多普勒导丝测量CFR。我们检查了给药前后心率（HR）、平均血压（mBP）、12导联心电图QTc间期总分（sigma QTc）以及ST-T段的变化。在注射0.5 mg（1.9±0.9）和1.0 mg（2.2±0.9）NIC期间，CFR显著低于注射PAP期间（2.6±1.1）（P<0.01）。在注射2.0 mg（2.6±1.0）或3.0 mg（2.5±1.0）NIC期间与注射PAP期间观察到的CFR无显著差异。注射PAP期间的CFR与注射2.0 mg NIC期间（r2 = 0.72，P<0.0001）和3.0 mg NIC期间（r2 = 0.70，P<0.0001）显著相关。PAP而非NIC显著改变了HR、mBP和sigma QTc。在注射PAP期间（包括1例室性心动过速患者），14例患者出现T波倒置，4例患者出现ST段抬高。除1例患者外，注射0.5 mg至2.0 mg NIC与ST-T段变化无关，但在注射3.0 mg NIC期间，2例患者出现T波倒置，2例患者出现ST段压低。冠状动脉内注射NIC对于评估CFR是有用且安全的。测量CFR的合适剂量为2.0 mg尼可地尔。
