The Therapeutic Effects Of Nicorandil On Cardiac Ⅹ Syndrome Patients

Objective:To explore the therapeutic effect of the potassium channel opener nicorandil on the symptom of angina pectoris、exercise tolerance and coronary flow reserve、endothelial inflammation level of Cardiac X Syndrome (CXS) patients on the basis of the usual therapy, and to study the mechanism of nicorandil on CXS.Methods:The clinical trial is a randomized、prospective、single-blind fashion. Collect datas of40CXS patients in Department of Cardiology of Provincial Hospital affiliated to Shandong University, including the center and east district of the hospital, from November2010to February2012. They were randomly allocated into the control group(usual therapy,20cases,7male cases,13female cases, and5smokers, use Aspirin、Metoprolol sustained-release tablet and Rosuvastatin) and the therapy group (usual therapy and nicorandil,20cases,7male cases,13female cases, and5smokers, use Aspirin、Metoprolol sustained-release tablet、Rosuvastatin and Nicorandil), according to the sex and whether smoking. Weekly anginal episodes、results of treadmill exercise tests and hypersensitive C-reactive protein(hs-CRP) level were measured before and after8weeks’treatment. In the treadmill exercise test, the maximal ST segment depression、 patients with positive result and angina pectoris during the test are used to assess myocardial ischemia; Rate-Pressure Product (RPP) is used to assess myocardial oxygen consumption. When the myocardial oxygen consumption is increased, the group whose coronary blood flow is not increased markedly will occur myocardial ischemia. With the same myocardial oxygen consumption, the better the coronary flow reserve, the lower the myocardial ischemia. CXS patients have inflammation, and the hs-CRP level of CXS patients is related to vascular endothelial dysfunction. Results:1.Weekly anginal episode:Both the two groups decreased markedly after therapy(the control group P<0.0001, the therapy group P<0.0001), but the therapy group decreased much markedly(P=0.008).2.Results of treadmill exercise tests:The heart rates、systolic pressures and RPPs of the two groups at rest have no difference after therapy (P>0.05). At the extreme excise of the exercise test, the RPP of the control group didn’t decrease significantly after therapy (P=0.054), the RPP of the therapy group didn’t change significantly after therapy (P=0.419), and the RPPs of the two groups after therapy had no difference(P=0.454); Both the exercise durations of the two groups increased after therapy(both group:P<0.0001),but the therapy group increased much markedly (P=0.001); Both the maximal ST segment depression of the two groups decreased after therapy(the control group P=0.01,the therapy group P<0.0001), but the therapy group decreased much markedly (P=0.027); In the therapy group, the patients with angina pectoris during the test decreased much markedly(P=0.025), the patients with positive result decreased much markedly(P=0.022).3.the hs-CRP level:The hs-CRP level of the two groups decreased markedly after therapy(both group:P<0.0001),but the therapy group decreased much markedly(P=0.003).Conclusions:1.Nicorandil could decrease the weekly anginal episode of CXS patients markedly.2.Nicorandil didn’t affect heart rate、systolic pressure and RPP at rest and the extreme excise after8weeks’treatment. In the treadmill exercise test, the RPPs of the two groups had no difference after therapy, which meaned they had the same myocardial oxygen consumption; however, the myocardial ischemia of the therapy group was decreased at this moment, and the exercise duration of therapy group was longer, which meaned the coronary blood flow of the therapy group was increased, so we could obtain that nicorandil could improve myocardial oxygen supply、coronary flow reserve and exercise tolerance of CXS patients.3.Nicorandil could reduce the hs-CRP level, and hs-CRP is related to the vascular endothelial dysfunction, so nicorandil could improve the vascular endothelial dysfunction of CXS patients.