Summary
We investigated the usefulness of the intracoronary administration of nicorandil (NIC) compared with that of papaverine (PAP) in the evaluation of coronary flow reserve (CFR) in 17 patients, including 10 patients with old myocardial infarction and 7 patients with angina pectoris. CFR was measured with a Doppler guidewire inserted into the distal site of the left anterior descending coronary artery during intracoronary administration of 10 mg PAP, and of 0.5 mg, 1.0 mg, 2.0mg, and 3.0 mg NIC. We examined the changes in heart rate (HR), mean blood pressure (mBP), the total score of QTc interval on a 12-lead electrocardiogram (∑ QTc), and ST-T segment, before and after drug administration. CFR was significantly lower during administration of 0.5 mg (1.9 ± 0.9) and 1.0 mg (2.2 ± 0.9) NIC than during administration of PAP (2.6 ± 1.1) (P < 0.01). There was no significant difference in the CFR during administration of 2.0 mg (2.6 ± 1.0) or 3.0mg (2.5 ± 1.0) NIC and that observed during administration of PAP. The CFR during administration of PAP was significantly correlated with that during administration of 2.0 mg NIC (r 2 = 0.72, P < 0.0001) and 3.0mg NIC (r 2 = 0.70, P < 0.0001). PAP, but not NIC, significantly altered the HR, mBP, and ∑ QTc. Inverted T waves were observed in 14 patients, and elevation of the ST segment was observed in 4 patients during administration of PAP (including 1 patient with ventricular tachycardia). The administration of 0.5 mg to 2.0 mg NIC was not associated with ST-T segment changes, except in 1 patient, but inverted T waves were observed in 2 patients and depression of the ST segment was observed in 2 patients during administration of 3.0mg NIC. Intracoronary administration of NIC is useful and safe for evaluating the CFR. The appropriate dose for measuring CFR is 2.0 mg nicorandil.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ishihara M, Sato H, Takeishi H, Kawagoe T, Yoshimura M, Muraoka Y (1993) Impaired coronary flow reserve immediately after coronary angioplasty in patients with acute myocardial infarction. Br Heart J 69:288–292
Klein LW, Agarwal JB, Schneider RM, Hermann G, Weintraub WS, Helfant RH (1986) Effect of previous myocardial infarction on measurements of reactive hyperemia and coronary vascular reserve. J Am Coll Cardiol 8:357–363
White CW (1993) Clinical applications of Doppler coronary flow measurements. Am J Cardiol 71:10D–16D
Offili EO, Labuvitz AJ, Kern MJ (1993) Coronary flow velocity dynamics in normal and diseased arteries. Am J Cardiol 71:3D–9D
Wilson RT, White CW (1986) Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious human. Circulation 73:444–451
Taira N (1989) Nicorandil as a hybrid between nitrates and potassium channel actors. Am J Cardiol 63:18J–24J
Vehate A, Matsuguchi T, Bitlel JA, Orar J, Meredith IT, Anderson TJ, Selwyn AP, Ganz P, Yeung AC (1993) Accuracy of electronic digital calipers compared with quantitative angiography in measuring coronary arterial diameter. Circulation 88:1724–1729
Hongo M, Takenaka H, Uchikawa S, Nakatsuka T, Watanabe N, Sekiguchi M (1995) Coronary microvascular response to intracoronary administration of nicorandil. Am J Cardiol 75:246–250
Hodgson J McB, Williams DU (1987) Superiority of intracoronary papaverine to radiographic contrast for measuring coronary flow reserve in patients with ischemic heart disease. Am Heart J 114:704–711
Doucette JW, Corl PD, Payne HM, Flynn AE, Goto M, Nassi M, Segal J (1992) Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 85:1899–1911
Segal J, Kern MJ, Scott NA, King SB, Doucette JW, Haucert RR, Ofili E (1992) Alternation of phasic coronary artery flow velocity in man during percutaneous coronary angioplasty. J Am Coll Cardiol 20:276–286
Hoffman JIE (1984) Maximal coronary flow and concept of coronary vascular reserve. Circulation 70:153–159
Ganz W, Tamura K, Marcus HS, Donosa R, Yushida S, Swan HJC (1971) Measurement of coronary sinus blood flow by continuous thermodilation in man. Circulation 44:181–187
Nissen SE, Elion JL, Booth PC, Evans J, DeMaria AN (1986) Value and limitation of computer analysis of digital subtraction angiography in the assessment of coronary flow reserve. Circulation 86:562–571
Schelbert HR, Winsenberg G, Phelpes ME (1982) Noninvasive assessment of coronary vasodilation VI Detection of coronary artery disease in human beings with intravenous N-13 ammonia positron computed tomography. Am J Cardiol 49:1197–1207
Ross RS, Veda K, Lichtlen PR, Rees JR (1964) Measurement of myocardial blood flow in animals and man by selective injection of radioactive inert gas into the coronary arteries. Circ Res 28:28–41
Marcus ML, Wright C, Doty D, Eastham C, Laughlin D, Krumm P, Fastenow C, Brody M (1981) Measurements of coronary velocity and reactive hyperemia in the coronary circulation of humans. Circ Res 49:877–891
Marcus ML, Doty DB, Hiratzuka LF, Wright CB, Eastham CL (1982) A mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 25:1326–1366
White CW (1993) Clinical application of Doppler coronary flow reserve measurements. Am J Cardiol 71:10D–16D
Zijlsta F, Julliere Y, Serruys PW (1988) Value and limitation of intracoronary adenosine for the assessment of coronary flow reserve. Cathet Cardiovasc Diagn 15:76–80
Antony I, Nitenberg A, Foult JM, Aptecar E (1993) Coronary vasodilator reserve in untreated and treated hypertensive patients with and without left ventricular hypertrophy. J Am Coll Cardiol 22:514–520
Ofili EO, Kern MJ, Lalovitz AJ, Vrian JA, Segal J, Aguirre F V, Castello R (1993) Analysis of coronary blood flow velocity dynamics in angiographically normal and stenosed arteries before and after endolumen enlargement by angioplasty. J Am Coll Cardiol 21: 308–316
Rossen JD, Winniford MD (1993) Effect of increase in heart arterial pressure on coronary flow reserve in human. J Am Coll Cardiol 21:343–348
Nahser PJ Jr, Brown RE, Oakarsson H, Winnifold MD, Rossen JD (1995) Maximal coronary flow reserve and metabolic coronary vasodilation in patients with diabetes mellitus. Circulation 91:635–640
McGinn AL, White CW, Wilson RF (1990) Interstudy variability of coronary flow reserve. Infuence of heart rate, arterial pressure, and ventricular preload. Circulation 81:1319–1330
Edwards GM, Weston AH (1993) The pharmacology of ATP sensitive potassium channels. Annu Rev Pharmacol Toxicol 33:597–637
Takayama T, Saito S, Hunye J, Ozawa Y, Kanmatsuse K, Fu T (1995) Safety and efficacy of intracoronary administration of nicorandil in human evaluated by intracoronary electrocardiogram, Doppler flow wire and coronary sinus O2 saturation. Ther Res 16:812–819
Iwasaki K, Sawanobori T, Tamura K (1991) The assessment of coronary flow reserve in canine. Intramyocardial and epicardial coronary arteries (in Japanese). Myaku-kangaku 31:1453–1461
Hashimoto K, Kinoshita M, Ohbayashi Y (1991) Coronary effects of nicorandil in comparison with nitroglycerin in chronic conscious dogs. Cardiovasc Drugs Ther 5:131–138
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Inoue, F., Hashimoto, T., Fujimoto, S. et al. Estimation of coronary flow reserve by intracoronary administration of nicorandil: comparison with intracoronary administration of papaverine. Heart and Vessels 13, 229–236 (1998). https://doi.org/10.1007/BF03257245
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03257245