Efficacy Of Nicorandil On Cardiac Function Of Patients With Ischemic Cardiomyopathy

Objective: The study compared changes of cardiac function, and majoradverse cardiac events (MACE) in nicorandil and isosorbide mononitrate toischemic cardiomyopathy, to research the nicorandil to affect cardiac functionand prognosis of ischemic cardiomyopathy patients, in order to provide singlecenter evidence of clinical for medicinal treatment of ischemiccardiomyopathy.Methods: Atotal of64patients who had been diagnosed as ischemiccardiomyopathy in our department were enrolled into this study from January2011to June2013. All enrolled patients were randomized into nicorandilgroup32patients (average age60.30±10.57years, male24cases and female8cases) and isosorbide mononitrate group32patients (average age63.18±12.84years, male20cases and female12cases). Nicorandil group patientswere administrated of nicorandil (10mg po tid) on the basis of conventionaltherapy (aspirin, clopidogrel, β receptor blocker, aldosterone antagonist,diuretic, digitalis, angiotensin converting enzyme inhibitors, angiotensinreceptor inhibitor); isosorbide mononitrate group patients were administratedof isosorbide mononitrate sustained-release tablets (60mg po qd) on the basisof conventional therapy. The baseline demographics and clinical features wereobserved respectively. Brain natriuretic peptide (BNP) and6-minute walkingtest distance were measured before,1month,3months and6months aftertreatment. Echocardiography(LVEF, LVESVI,LVEDVI and E/A rate) weremeasured before and6months after treatment. The follow-up MACE wasevaluated until6months after treatment. Data analysis was performed byPASW20.0software, and P<0.05was considered statistically significant.Result:1Comparison of baseline demographics and clinical features between two groups: No significant differences were found with respect to baselinedemographics and clinical features, such as age, gender, body mass index,smoking history, complications, SYNTAX score, GRACE score, CRUSADEscore, heart function classification and basic drug strategy (P>0.05).2Comparison of BNP and cardiac function between two groups: Therewas no significant difference between two groups before treatment, such asBNP, distance of6-minute walking test performance, LVEF, LVESVI,LVEDVI, E/A rate (P>0.05). At6months after the treatment, BNP ofisosorbide mononitrate group was lower than that before treatment (258.81ng/ml VS219.78ng/ml P=0.045), but BNP of nicorandil group was lower thanthat before treatment at3months (253.75ng/ml VS178.88ng/ml P=0.027).6months later, BNP of nicorandil group was lower than that of isosorbidemononitrate group (178.88ng/ml VS219.78ng/ml P=0.042). Distance of6-minute walking test performance of Nicorandil group was longer than thatbefore treatment after1month (299.63m VS329.28m P=0.041), but inisosorbide mononitrate group distance of6-minute walking test performancewas longer than that before treatment after3months (295.41m VS333.53mP=0.034).6months later, distance of6-minute walking test performance ofnicorandil group was longer than that of isosorbide mononitrate group(374.47m VS342.31m P=0.032). Nicorandil group brought improvement ofLVEF and E/A rate (45.20%VS48.43%P=0.039；0.96VS1.17P=0.031),LVESVI and LVEDVI were significantly lower at6months after treatment(60.13ml/m2VS50.29ml/m2P=0.029,83.46ml/m2VS76.12ml/m2P=0.041).And t test between the two groups achieved that at6months after thetreatment, the levels of LVESVI, LVEDVI in nicorandil group significantlyreduced compared with control group (50.29ml/m2VS56.13ml/m2P=0.031，76.12ml/m2VS80.07ml/m2P=0.043), and E/A rate in nicorandil groupsignificantly increased compared with control group (1.17VS1.02P=0.026).However, there was no significant difference between the two groups in LVEFafter180d treatment (P=0.085).3Comparison of cumulative MACE between two groups: In hospital， there were no incidences of MACE in two groups; At six-months follow up,there were two incidences of MACE in nicorandil group;but seven incidencesof MACE in isosorbide mononitrate group,and significantly increasedcompared with nicorandil group (P=0.038).Conclusion:1Nicorandil was superior to the traditional nitrates in clinical efficacy ofischemic cardiomyopathy.2Nicorandil could significantly improve cardiac diastolic function amo-ng ischemic cardiomyopathy patients, but no significant difference was foundabout cardiac systolic function among ischemic cardiomyopathy patients.3Nicorandil could improve prognosis of ischemic cardiomyopathypatients.