长期应用尼可地尔治疗可改善首次急性心肌梗死患者再灌注治疗后的心脏交感神经活动。
Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction.
作者信息
Kasama Shu, Toyama Takuji, Sumino Hiroyuki, Kumakura Hisao, Takayama Yoshiaki, Ichikawa Shuichi, Suzuki Tadashi, Kurabayashi Masahiko
机构信息
Department of Cardiovascular Medicine, Gunma University School of Medicine, Maebashi, Japan.
出版信息
J Nucl Med. 2007 Oct;48(10):1676-82. doi: 10.2967/jnumed.107.043075. Epub 2007 Sep 14.
UNLABELLED
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 (123)I-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 beta-blockers. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from (123)I-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.
未标记
尼可地尔是一种三磷酸腺苷敏感性钾通道开放剂，可降低缺血性心脏病患者的血浆去甲肾上腺素浓度。然而，急性心肌梗死（AMI）患者经（123）I-间碘苄胍（MIBG）闪烁显像评估的对心脏交感神经活动（CSNA）的长期影响尚未确定。
方法
我们研究了40例首次发生AMI且在直接冠状动脉血管成形术前后接受静脉注射尼可地尔治疗的患者。在停止初始静脉注射尼可地尔治疗后，20例患者随机接受口服尼可地尔（15mg/d）（A组），另外20例患者接受安慰剂（B组）。所有患者还接受了血管紧张素转换酶（ACE）抑制剂或β受体阻滞剂治疗。在血管成形术后3周和6个月通过（123）I-MIBG闪烁显像测定延迟的心/纵隔计数比值（H/M比值）、延迟的总缺损评分（TDS）和洗脱率（WR）。通过对比左心室造影测定左心室（LV）舒张末期容积（EDV）、LV收缩末期容积（ESV）和LV射血分数（EF），同时在相同时间点测量血浆III型前胶原氨基末端肽（PIIINP）浓度。
结果
血管成形术后3周，两组的TDS、H/M比值、WR、LVEDV、LVESV和LVEF相似。6个月后，两组所有这些参数均有所改善。然而，A组TDS的变化程度为-9±6，B组为-5±6（P<0.05），H/M比值的变化程度为0.15±0.13和0.07±0.11（P<0.05），WR的变化程度为-12%±8%和-5%±11%（P<0.05）。A组LVEDV、LVESV和LVEF的变化程度倾向于超过B组，但这些变化无统计学意义。我们发现A组从基线到6个月PIIINP的变化百分比与TDS的变化百分比之间存在显著相关性（r=0.456，P<0.05）。
结论
对于AMI患者，长期尼可地尔治疗在CSNA和LV重塑方面可能比短期治疗更有益。
Zotero 插件