Acute effects of intravenous nicorandil on hemodynamics in patients hospitalized with acute decompensated heart failure.
BACKGROUND
Nicorandil injection, a potent vasodilator with K(ATP) channel opening action and nitrate-like action, has been used for treatment of unstable angina. In the present investigation, we examined the effect of intravenous nicorandil on hemodynamics in patients with acute decompensated heart failure (ADHF).


METHODS
ADHF patients admitted to hospital with pulmonary artery wedge pressure (PAWP)≥18 mm Hg were enrolled. Patients received nicorandil by an intravenous bolus injection of 0.2mg/kg/5 min followed by continuous infusion at a rate of 0.05, 0.10, or 0.20mg/kg/h for 6h.


RESULTS
Nicorandil administration caused a significant decrease in PAWP and increase in the cardiac index (CI) that began immediately after the injection and were maintained during the continuous infusion. After 6h, nicorandil administration at 0.2mg/kg/5 min followed by 0.20mg/kg/h resulted in a decrease in PAWP (26.5%, p<0.01), an increase in CI (15.8%, p<0.05), and a decrease in total peripheral resistance (13.8%, p<0.01) in a dose-dependent manner. Nicorandil decreased blood pressure significantly, without an excessive decrease or negative impact even in patients with lower systolic blood pressure.


CONCLUSIONS
Intravenous administration of nicorandil, by bolus injection followed by continuous infusion, improves PAWP and CI in ADHF patients immediately and continuously as a potent vasodilator with combined preload and afterload reduction. These results demonstrate that nicorandil is a safe and effective new medication for the treatment of ADHF.
Tanaka
Keiji
K
Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113 8603, Japan. k-tanaka@nms.ac.jp
Kato
Kazuzo
K
Takano
Teruo
T
Katagiri
Takashi
T
Asanoi
Hidetsugu
H
Nejima
Jun
J
Nakashima
Mitsuyoshi
M
Kamijo
Takeshi
T
Sakanashi
Matao
M
D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000008:administration & dosage*; D011669:Pulmonary Wedge Pressure; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D020108:Nicorandil