Nicorandil effect on myocardial perfusion in patients with slow coronary flow phenomenon assessment by gated myocardial perfusion SPECT

Document Type: Original Article

Authors

1 Nuclear Medicine Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cardiovascular Department, Imam Reza Hospital, Mashhad University of Medical Sciences. Mashhad, Iran

Abstract

Introduction:Patients with the coronary slow flow phenomenon (SCF) frequently experience angina episodes. The purpose of this study was to determine efficacy of nicorandil in myocardial perfusion in patients with SCF.
Methods: Twenty patients (50.85 ± 12.96 y) with SCF were studied.  We evaluate coronary slow flow according to protracted thrombolysis in myocardial infarction (TIMI) frame count. After diagnosis of SCF, all patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT. Subsequently, the patients received 10 mg nicorandil BD (20 mg per day). After starting nicorandil for one month, patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT again. Gated SPECT images were analyzed based on 17-segment scoring system, and QPS (quantitative perfusion SPECT) and QGS (quantitative gated SPECT) softwares were used.
Results: In patients with SCF subtle perfusion abnormality was noticed. With nicorandil consumption, EDV and ESV were decreased and LVEF was increased in both stress and rest gated SPECT phases (P>0.05). After nicorandil consumption, decreased in most semi-quantitative perfusion indices (Severity score; P=0.03, Extension score; P=0.06, RAW reversibility; P=0.002, severity reversibility; P=0.03 and Extension reversibility; P=0.001) except for RAW score were observed demonstrating significant difference with pre-nicorandil consumption quantities.  In multi-vessels involvement with SCF, there was a trend to see more abnormality with more remarkable post-nicorandil change as compared to the patients with one vessel involvement.

Conclusion: The main finding of this study was better myocardial coronary flow after nicorandil consumption in patients with SCF specially those with multi-vessel involvement.

Keywords

Main Subjects


  1. Karagounis L, Sorensen SG, Menlove RL, Moreno F, Anderson JL. Does thrombolysis in myocardial infarction (TIMI) perfusion grade 2 represent a mostly patent artery or a mostly occluded artery? Enzymatic and electrocardiographic evidence from the TEAM-2 study. Second Multicenter Thrombolysis Trial of Eminase in Acute Myocardial Infarction. J Am Coll Cardiol. 1992 Jan;19(1):1-10.
  2. Ito H, Okamura A, Iwakura K, Masuyama T, Hori M, Takiuchi S, Negoro S, Nakatsuchi Y, Taniyama Y, Higashino Y, Fujii K, Minamino T. Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation. 1996 Jun 1;93(11):1993-9.
  3. Abbo KM, Dooris M, Glazier S, O'Neill WW, Byrd D, Grines CL, Safian RD. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol. 1995 Apr 15;75(12):778-82.
  4. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002 Feb 5;105(5):656-62.
  5. Kotani J, Nanto S, Mintz GS, Kitakaze M, Ohara T, Morozumi T, Nagata S, Hori M. Plaque gruel of atheromatous coronary lesion may contribute to the no-reflow phenomenon in patients with acute coronary syndrome. Circulation. 2002 Sep 24;106(13):1672-7.
  6. Taira N. Nicorandil as a hybrid between nitrates and potassium channel activators. Am J Cardiol. 1989 Jun 20;63(21):18J-24J.
  7. Miura T, Kawamura S, Tatsuno H, Ikeda Y, Mikami S, Iwamoto H, Okamura T, Iwatate M, Kimura M, Dairaku Y, Maekawa T, Matsuzaki M. Ischemic preconditioning attenuates cardiac sympathetic nerve injury via ATP-sensitive potassium channels during myocardial ischemia. Circulation. 2001 Aug 28;104(9):1053-8.
  8. Ishii H, Ichimiya S, Kanashiro M, Amano T, Imai K, Murohara T, Matsubara T. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocardial infarction. Circulation. 2005 Aug 30;112(9):1284-8.
  9. Ito H, Taniyama Y, Iwakura K, Nishikawa N, Masuyama T, Kuzuya T, Hori M, Higashino Y, Fujii K, Minamino T. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol. 1999 Mar;33(3):654-60.
  10. Sakata Y, Kodama K, Komamura K, Lim YJ, Ishikura F, Hirayama A, Kitakaze M, Masuyama T, Hori M. Salutary effect of adjunctive intracoronary nicorandil administration on restoration of myocardial blood flow and functional improvement in patients with acute myocardial infarction. Am Heart J. 1997 Jun;133(6):616-21.
  11. IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002 Apr 13;359(9314):1269-75.
  12. Glover DK, Ruiz M, Koplan BA, Watson DD, Beller GA. 99mTc-tetrofosmin assessment of myocardial perfusion and viability in canine models of coronary occlusion and reperfusion. J Nucl Med. 1999 Jan;40(1):142-9.
  13. Kaul S, Villanueva FS. Is the determination of myocardial perfusion necessary to evaluate the success of reperfusion when the infarct-related artery is open? Circulation. 1992 May;85(5):1942-4.
  14. Kaul S. Assessing the myocardium after attempted reperfusion: should we bother? Circulation. 1998 Aug 18;98(7):625-7.
  15. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996 Mar 1;93(5):879-88.
  16.  Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation. 1996 Mar 1;93(5):905-14.
  17. Dabbagh Kakhki VR, Jabari H. Dipyridamole stress and rest gated 99mTc-sestamibi myocardial perfusion SPECT: left ventricular function indices and myocardial perfusion findings. Iran J Nucl Med. 2007;15(1):1-7.
  18. Kakhki VR, Zakavi SR, Sadeghi R. Comparison of two software in gated myocardial perfusion single photon emission tomography, for the measurement of left ventricular volumes and ejection fraction, in patients with and without perfusion defects. Hell J Nucl Med. 2007 Jan-Apr;10(1):19-23.
  19. Zakavi SR, Zonoozi A, Kakhki VD, Hajizadeh M, Momennezhad M, Ariana K. Image reconstruction using filtered backprojection and iterative method: effect on motion artifacts in myocardial perfusion SPECT. J Nucl Med Technol. 2006 Dec;34(4):220-3.
  20.  Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995 Nov;36(11):2138-47.
  21. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGoon DC, Murphy ML, Roe BB. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975 Apr;51(4 Suppl):5-40.
  22.  Sugimoto K, Ito H, Iwakura K, Ikushima M, Kato A, Kimura R, Tanaka K, Masuyama T, Ogihara T, Kawano S, Fujii K. Intravenous nicorandil in conjunction with coronary reperfusion therapy is associated with better clinical and functional outcomes in patients with acute myocardial infarction. Circ J. 2003 Apr;67(4):295-300.
  23. Ono H, Osanai T, Ishizaka H, Hanada H, Kamada T, Onodera H, Fujita N, Sasaki S, Matsunaga T, Okumura K. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: role of inhibitory effect on reactive oxygen species formation. Am Heart J. 2004 Oct;148(4):E15.
  24. Sani HD, Eshraghi A, Nezafati MH, Vojdanparast M, Shahri B, Nezafati P. Nicorandil versus nitroglycerin for symptomatic relief of angina in patients with slow coronary flow phenomenon: A randomized clinical trial. J Cardiovasc Pharmacol Ther. 2015 Jul;20(4):401-6.
  25. Fukushima Y, Kumita S, Tokita Y, Sato N. Prognostic value of myocardial perfusion SPECT after intravenous bolus administration of nicorandil in patients with acute ischemic heart failure. J Nucl Med. 2016 Mar;57(3):385-91.
  26. Hida S, Chikamori T, Tanaka H, Igarashi Y, Shiba C, Hatano T, Usui Y, Yamashina A. Postischemic myocardial stunning is superior to transient ischemic dilation for detecting multivessel coronary artery disease. Circ J. 2012;76(2):430-8.