Authors: Shu Kasama Takuji Toyama Hisao Kumakura Yoshiaki Takayama Shuichi Ichikawa Tadashi Suzuki Masahiko Kurabayashi
Publish Date: 2004/10/02
Volume: 32, Issue: 3, Pages: 322-328
Abstract
Ischaemic preconditioning PC is a cardioprotective phenomenon in which short periods of myocardial ischaemia result in resistance to decreased contractile dysfunction during a subsequent period of sustained ischaemia Nicorandil an ATPsensitive potassium channel opener can induce PC effects on sympathetic nerves during myocardial ischaemia However its effects on cardiac sympathetic nerve activity CSNA and left ventricular remodelling have not been determined In this study we sought to determine whether nicorandil administration improves CSNA in patients with acute myocardial infarction AMIWe studied 58 patients with first anterior AMI who were randomly assigned to receive nicorandil group A or isosorbide dinitrate group B after primary coronary angioplasty The nicorandil or isosorbide dinitrate was continuously infused for 48 h The extent score ES was determined from 99mTcpyrophosphate scintigraphy and the total defect score TDS was determined from 201Tl scintigraphy 3–5 days after primary angioplasty The left ventricular enddiastolic volume LVEDV and left ventricular ejection fraction LVEF were determined by left ventriculography 2 weeks later The delayed heart/mediastinum count H/M ratio delayed TDS and washout rate WR were determined from 123Imetaiodobenzylguanidine MIBG images 3 weeks later The left ventriculography results were reexamined 6 months after treatmentFifty patients originally enrolled in the trial completed the entire protocol After treatment no significant differences were observed in ES or left ventricular parameters between the two groups However in group A n=25 the TDSs determined from 201Tl and 123IMIBG were significantly lower 26±6 vs 30±5 P001 and 32±8 vs 40±6 P00001 respectively the H/M ratio significantly higher 199±016 vs 177±030 P0005 and the WR significantly lower 36±8 vs 44±12 P0005 than in group B n=25 Moreover 6 months after treatment LVEDV and LVEF were better in group A than in group B
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