Yokota M, Horisawa T, Iwase M, Miyahara T, Yoshida J, Kamihara S, Noda S, Tsunekawa A, Koide M, Tsuzuki M
First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
J Cardiovasc Pharmacol. 1987;10 Suppl 8:S116-22.
Hemodynamic effects of nicorandil on exercise-induced impairment of left ventricular function were studied in nine patients with old myocardial infarction but without angina pectoris. Hemodynamic data were obtained by symptom-limited supine multistage bicycle ergometer exercise testing before and 1 h after single oral administration of 15 mg of nicorandil. Systolic and diastolic blood pressure at rest decreased significantly after nicorandil administration (p less than 0.01). A most remarkable change in the hemodynamic response to supine dynamic exercise after nicorandil was a decrease in pulmonary artery wedge pressure (both at rest and at peak exercise, p less than 0.001). An index cardiac function, obtained from the relation between pulmonary artery wedge pressure and left ventricular stroke work index, improved significantly after nicorandil. The ration of pressure-rate product to coronary sinus flow, which is an index of the ratio of myocardial oxygen consumption to myocardial oxygen supply, decreased significantly (p less than 0.05) after nicorandil administration. Reproducibility of the testings was also studied in six patients with old myocardial infarction. Invasive hemodynamic variables between two successive symptom-limited supine leg exercise testings, except pulmonary artery wedge pressure, were reproducible in patients with old myocardial infarction but without angina pectoris. Only pulmonary artery wedge pressure at rest in the second exercise testing showed a significantly lower value (p less than 0.05). It is concluded that nicorandil is a useful drug for improvement of exercise-induced impairment of left ventricular function with an increase in myocardial oxygen supply.
研究了尼可地尔对9例陈旧性心肌梗死但无心绞痛患者运动诱发的左心室功能损害的血流动力学效应。在单次口服15 mg尼可地尔之前和之后1小时，通过症状限制的仰卧位多级自行车测力计运动试验获取血流动力学数据。服用尼可地尔后，静息时的收缩压和舒张压显著降低（p<0.01）。尼可地尔治疗后，对仰卧位动态运动的血流动力学反应最显著的变化是肺动脉楔压降低（静息时和运动峰值时，p<0.001）。根据肺动脉楔压与左心室每搏功指数之间的关系得出的心脏功能指标，在服用尼可地尔后显著改善。压力-心率乘积与冠状窦血流的比值，即心肌耗氧量与心肌供氧量的比值指标，在服用尼可地尔后显著降低（p<0.05）。还对6例陈旧性心肌梗死患者进行了测试的可重复性研究。在陈旧性心肌梗死但无心绞痛的患者中，两次连续的症状限制仰卧位腿部运动试验之间的有创血流动力学变量（肺动脉楔压除外）是可重复的。第二次运动试验中仅静息时的肺动脉楔压显示出显著较低的值（p<0.05）。结论是，尼可地尔是一种有助于改善运动诱发的左心室功能损害并增加心肌供氧量的药物。
