Clinical Evaluation Of Nicorandil On Heart Function In Patients With Ischemic Heart Disease And Heart Failure

Ischemic cardiomyopathy(ICM)is due to long-term coronary atherosclerosis,resulting in chronic myocardial insufficiency,myocardial dystrophy and atrophy,resulting in myocardial remodeling,heart limitations or(and)diffuse Sexual fibrosis and other pathophysiological changes,leading to enlargement of the heart,arrhythmia and heart failure appear as the main feature of a group of clinical syndromes.Therefore,heart failure is the terminal stage of ischemic cardiomyopathy,once progress to heart failure stage,the mortality rate will be significantly increased.At present,conventional treatment to take medication such as aspirin and / or clopidogrel,diuretics,statins,angiotensin converting enzyme inhibitors or angiotensin Receptor Blocker,?-blockers,cardiotonics and other non-drug treatment Drug therapy such as coronary intervention,coronary artery bypass graft,cardiac resynchronization therapy,heart transplantation and other treatment,but we found that clinical outcomes are still not ideal.So,this allows us to turn our attention to coronary microcirculation.Nicorandil,as a new type of drug for improving microcirculation,can act on vascular smooth muscle cells,open KATP channel,increase potassium outflow,hyperpolarization of cell membrane and inhibit voltage-dependent calcium ion Channel,resulting in vascular smooth muscle relaxation,so as to achieve the diastolic blood vessels and small coronary artery.On the other hand,KATP can mitigate mitochondrial Ca 2+ overload,increase mitochondrial diastolic function,enhance respiratory function and increase ATP by exerting potassium ion influx in mitochondrial membrane to protect the heart.Nicorandil,meanwhile,is also a nitric oxide donor that produces large amounts of nitric oxide and activates guanylate cyclase on vascular smooth muscle cells to achieve the nitric-oxide effect of dilated systemic and epicardial coronary arteriesStudies have confirmed that nicorandil can effectively improve the symptoms and seizures of angina,reduce transient myocardial ischemia and arrhythmia,and can be used as a class ?recommended angina pectoris medication.At present,there is not enough evidence for the treatment of heart failure due to ischemic cardiomyopathy.At home and abroad,nicorandil is mostly used for intravenous drug use.This article aims to investigate the effect of oral nicorandil on heart failure in patients with ischemic cardiomyopathy Function of the clinical efficacy,so as to provide guidance for clinical treatment.Objective:To investigate the clinical effect of oral nicorandil on improving cardiac function in patients with heart failure of ischemic cardiomyopathy.Methods:A total of 60 patients with chronic heart failure diagnosed as ischemic cardiomyopathy hospitalized in Department of Cardiology,Hebei Provincial People's Hospital from May 2016 to September 2017 were randomly divided into experimental group and control group,with 30 cases in each group,And the control group was treated with conventional drugs,including diuretics,angiotensin converting enzyme inhibitors or angiotensin receptor blockers,?-blockers,calcium channel blockers,statins,nitrates,Such as high-Xin.The Nicorandil group was treated with Nicorandil(5 mg three times daily)on a routine basis.The left ventricular end-systolic diameter(LVESD),end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF%)and Left ventricular fractional shortening(LVFS%0,followed up for 12 months.The primary end points of the two groups were compared: composite end point of all-cause death at 12 months,cardiac death,and HF rehospitalization.Secondary endpoints;including myocardial infarction,stroke,and ventricular arrhythmias.Result:After 3 months of treatment,LVEF% in the experimental group was statistically different from that before treatment(P <0.05),while LVESD,LVEDD and LVFS% were not statistically different(P >0.05).All patients were followed up for 12 months,There was no significant difference between the two groups in the primary endpoint events,with no significant difference in the secondary endpoint events between the two groups.Conclusion:Ischemic cardiomyopathy patients with heart failure oral nicorandil in the short term can improve heart function,but can not reverse the ventricular remodeling.We propose long-term oral nicorandil to improve cardiac function,reversal ventricular remodeling,reduce the number of heart failure rehospitalization and improve the quality of life.