title: Acute haemodynamic effects of nicorandil in patients with chronic severe regurgitant valvular lesions.
abstract: The haemodynamic effects of nicorandil, a new balanced vasodilator exhibiting nitrate-like as well as potassium-channel opening activity in patients with chronic severe valvular lesions have not been reported. We studied the acute effect of nicorandil on haemodynamics in 12 stable patients (6 males, 6 females; mean age 23.5 +/- 4.6 years) with chronic severe valvular regurgitation (8 mitral, 4 aortic). All patients were studied in resting, supine and fasting states. All cardioactive drugs were withdrawn five days prior to the study. Intra-arterial line was placed and thermodilution catheter was positioned in the pulmonary artery. Haemodynamic parameters recorded at baseline and at 30, 60, 90 and 120 minutes following a single oral dose of 20 mg nicorandil revealed no significant change in the heart rate while systemic pressures showed a small decline (p < 0.05). There was significant reduction in systolic, diastolic and mean pulmonary artery pressures (p < 0.001). The mean cardiac index increased from 3.16 L/min/m2 at baseline to 3.77 L/min/m2 at 60 minutes. Both the pulmonary and systemic vascular resistance indices reduced significantly, the peak fall being 18 percent and 29 percent, respectively. Maximal changes were observed at 60 to 90 minutes following administration of nicorandil. No adverse effect of nicorandil occurred during the study. We conclude that nicorandil has a favourable acute haemodynamic effect in patients with chronic severe valve regurgitation. Its long-term use in valvular lesions should be explored further.
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
authors.forename: R
authors.initials: R
authors.lastname: Yadav
authors.forename: B
authors.initials: B
authors.lastname: Bhargava
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: R
authors.initials: R
authors.lastname: Narang
authors.forename: A
authors.initials: A
authors.lastname: Chopra
authors.forename: R
authors.initials: R
authors.lastname: Sapra
authors.forename: S C
authors.initials: SC
authors.lastname: Manchanda
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020108:Nicorandil; D015221:Potassium Channels / Q000819:agonists; D012214:Rheumatic Heart Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000517:prevention & control
chemical_list: D015221:Potassium Channels; D014665:Vasodilator Agents; D009536:Niacinamide; D020108:Nicorandil