title: Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure.
abstract: Nicorandil, a hybrid adenosine triphosphate (ATP)-sensitive potassium channel opener and nitrate, is commonly used for the management of acute ischemic heart failure (AIHF). The aims of this study were to predict the effect of nicorandil by calculating myocardium-to-background ratio increasing rate (MBR-IR) using nicorandil stress myocardial perfusion SPECT and to evaluate the prognostic value of MBR-IR in patients with AIHF.
  
  
  METHODS
  Twenty-two patients (age, 70 ± 12 y) admitted to the coronary care unit with AIHF underwent nicorandil-stress and rest myocardial perfusion SPECT. Using these images, MBR-IR was calculated by dividing stress MBR by rest MBR (MBR = peak value of left ventricular myocardial segments/mean value of upper mediastinum). In order to evaluate the clinical importance of MBR-IR derived from the nicorandil-stress test, all patients were divided into 2 groups, based on the value of MBR-IR. All patients were observed over 5 y from the onset of AIHF for the occurrence of major adverse cardiac events (MACE).
  
  
  RESULTS
  Both high- and low-MBR-IR groups contained 11 participants. Median MBR-IR was 1.55 (1.34-1.61) in the high-MBR-IR group and 1.08 (1.02-1.10) in the low-MBR-IR group. The proportion of patients who experienced MACE was significantly higher in the low-MBR-IR group than in the high-MBR-IR group (91% vs. 18%, P < 0.001).
  
  
  CONCLUSIONS
  This study demonstrated that the MBR-IR calculated using nicorandil-stress myocardial perfusion SPECT may have a high prognostic value for MACE in patients with AIHF.
authors.affiliation: Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan; and fuku@nms.ac.jp.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Fukushima
authors.affiliation: Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan; and.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Kumita
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Tokita
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000378:metabolism; D020108:Nicorandil / Q000008:administration & dosage / Q000493:pharmacokinetics; D049268:Positron-Emission Tomography; D011379:Prognosis; D012146:Rest; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D014665:Vasodilator Agents; D020108:Nicorandil
keywords: acute ischemic heart failure; major adverse cardiac event; myocardium-to-background ratio increasing rate; nicorandil-stress myocardial perfusion imaging; single photon emission computed tomography