Acute effects of intravenous nicorandil on hemodynamics in patients hospitalized with acute decompensated heart failure

作者:Tanaka Keiji*; Kato Kazuzo; Takano Teruo; Katagiri Takashi; Asanoi Hidetsugu; Nejima Jun; Nakashima Mitsuyoshi; Kamijo Takeshi; Sakanashi Matao
来源:Journal of Cardiology, 2010, 56(3): 291-299.
DOI:10.1016/j.jjcc.2010.06.009

摘要

Background: Nicorandil injection, a potent vasodilator with K-ATP channel opening action and nitrate-like action, has been used for treatment of unstable angina. In the present investigation, we examined the effect of intravenous nicorandil on hemodynamics in patients with acute decompensated heart failure (ADHF).
Methods: ADHF patients admitted to hospital with pulmonary artery wedge pressure (PAWP) >= 18 mm Hg were enrolled. Patients received nicorandil by an intravenous bolus injection of 0.2 mg/kg/5 min followed by continuous infusion at a rate of 0.05, 0.10, or 0.20 mg/kg/h for 6 h.
Results: Nicorandil administration caused a significant decrease in PAWP and increase in the cardiac index (CI) that began immediately after the injection and were maintained during the continuous infusion. After 6h, nicorandil administration at 0.2 mg/kg/5 min followed by 0.20 mg/kg/h resulted in a decrease in PAWP (26.5%, p < 0.01), an increase in CI (15.8%, p < 0.05), and a decrease in total peripheral resistance (13.8%, p < 0.01) in a dose-dependent manner. Nicorandil decreased blood pressure significantly, without an excessive decrease or negative impact even in patients with lower systolic blood pressure.
Conclusion: Intravenous administration of nicorandil, by bolus injection followed by continuous infusion, improves PAWP and CI in ADHF patients immediately and continuously as a potent vasodilator with combined preload and afterload reduction. These results demonstrate that nicorandil is a safe and effective new medication for the treatment of ADHF.

  • 出版日期2010-11