Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction
Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction
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DOI：
10.2967/jnumed.107.043075
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发表时间：
2007-10-01
影响因子：
9.3
通讯作者：
Kurabayashi, Masahiko
中科院分区：
文献类型：
--
作者：
Kasama, Shu;Toyama, Takuji;Kurabayashi, Masahiko
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，尚未确定通过I-123 -间碘苄胍（MIBG）闪烁扫描法评估的对急性心肌梗死（AMI）患者心脏交感神经活动（CSNA）的长期影响。方法：我们研究了40例首次AMI患者，在直接冠状动脉成形术前后静脉注射尼可地尔。暂停初始静脉尼可地尔治疗后，20例患者随机接受口服尼可地尔（15 mg/d）（A组），其他20例患者接受安慰剂（B组）。所有患者均接受血管紧张素转换酶（ACE）抑制剂或β受体阻滞剂治疗。术后3 wk和6 mo行I-123-MIBG血管造影，测定延迟心脏与纵隔计数比值（H/M比值）、延迟总缺损评分（TDS）和洗脱率（WR）。左心室（LV）舒张末期容积（EDV），左心室收缩末期容积（ESV），左心室射血分数（EF）通过对比左心室造影，而血浆III型前胶原氨基末端肽（PIIINP）浓度也在相同的时间点进行了测量。结果：两组术后3周的TDS、H/M比值、WR、LVEDV、LVESV和LVEF相似。6个月后，两组的所有这些参数均有所改善。然而，TDS的变化程度在A组为-9 +/-6，在B组为-5 +/-6 H/M比值分别为0.15 ± 0.13和0.07 ± 0.11（P <0.05），WR分别为-12% ± 8%和-5% ± 11%（P < 0.05）。A组LVEDV、LVESV和LVEF的变化幅度有超过B组的趋势，但这些变化无统计学意义。A组PIIINP与TDS自基线至6个月的变化百分比之间存在显著相关性（r = 0.456，P < 0.05）。结论：尼可地尔长期治疗对AMI患者的CSNA和左室重构比短期治疗更有益。
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 I-123 -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 I-123-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.