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Improvement of myocardial fatty acid metabolism by oral nicorandil in hemodialysis patients without coronary artery disease

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Abstract

Background

We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism assessed by single-photon emission computed tomography (SPECT) using 123I-β-methyliodophenyl pentadecanoic acid (BMIPP) in hemodialysis patients without obstructive coronary artery disease (CAD).

Methods

This study was based on a cohort study of 155 hemodialysis patients with angiographic absence of obstructive CAD, with analysis performed in 100 propensity-matched patients (54 men and 46 women, 64 ± 10 years); 50 with oral administration of nicorandil (15 mg/d, nicorandil group) and 50 without (control). BMIPP SPECT was performed every year after angiography. Uptake on SPECT was graded in 17 segments on a five-point scale (0 normal, 4 absent) and assessed as BMIPP summed scores (SS).

Results

Over a mean follow-up period of 5.3 ± 1.9 years, we observed 25 cardiac deaths among 100 propensity-matched patients. Myocardial uptake of BMIPP in SPECT improved in the nicorandil group compared with the control group from 2 years of administration. In Kaplan–Meier survival analyses, free survival rate from cardiac death was higher in patients with a BMIPP SS improvement rate of ≥20 % compared to those with ≥0 % <20 % or with <0 % BMIPP SS improvement rate. At multiple logistic analysis, a ≥20 % BMIPP SS improvement rate was positively associated with serum albumin concentration and oral nicorandil.

Conclusions

Long-term oral nicorandil may inhibit cardiac death by improving myocardial fatty acid metabolism in hemodialysis patients without obstructive CAD.

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References

  1. Taira N, Satoh K, Yanagisawa T, Imai Y, Hiwatari M (1979) Pharmacological profile of a new coronary vasodilator drug, 2-nicotinamidoethyl nitrate (SG-75). Clin Exp Pharmacol Physiol 6:301–316

    Article  CAS  PubMed  Google Scholar 

  2. Kukovetz WR, Holzmann S, Braida C, Pöch G (1991) Dual mechanism of the relaxing effect of nicorandil by stimulation of cyclic GMP formation and by hyperpolarization. J Cardiovasc Pharmacol 17:627–633

    Article  CAS  PubMed  Google Scholar 

  3. Nishimura M, Tokoro T, Nishida M et al (2009) Clinical potential of nicorandil to inhibit major cardiac events in hemodialysis patients with suspected myocardial ischemia. Nephron Clin Pract 111:c212–c221

    Article  CAS  PubMed  Google Scholar 

  4. Nishimura M, Tokoro T, Nishida M et al (2009) Oral nicorandil to reduce cardiac death after coronary revascularization in hemodialysis patients: a randomized trial. Am J Kidney Dis 54:307–317

    Article  CAS  PubMed  Google Scholar 

  5. Nishimura M, Sakoda C, Murakawa M et al (2011) Oral nicorandil for prevention of cardiac death in hemodialysis patients without obstructive coronary artery disease: a propensity-matched patient analysis. Nephron Clin Pract 119(4):c301–c309

    Article  CAS  PubMed  Google Scholar 

  6. Nishimura M, Tsukamoto K, Hasebe N, Tamaki N, Kikuchi K, Ono T (2008) Prediction of cardiac death in hemodialysis patients by myocardial fatty acid imaging. J Am Coll Cardiol 51:139–145

    Article  CAS  PubMed  Google Scholar 

  7. Nishimura M, Tokoro T, Nishida M et al (2008) Myocardial fatty acid imaging identifies a group of hemodialysis patients at high risk for cardiac death after coronary revascularization. Kidney Int 74:513–520

    Article  PubMed  Google Scholar 

  8. Moroi M, Tamaki N, Nishimura M et al (2013) Association between abnormal myocardial fatty acid metabolism and cardiac-derived death among patients undergoing hemodialysis: results from a cohort study in Japan. Am J Kidney Dis 61:466–475

    Article  CAS  PubMed  Google Scholar 

  9. Nishimura M, Tsukamoto K, Tamaki N, Kikuchi K, Iwamoto N, Ono T (2011) Risk stratification for cardiac death of hemodialysis patients without obstructive coronary artery disease. Kidney Int 79:363–371

    Article  PubMed  Google Scholar 

  10. Kuwabara Y, Watanabe S, Nakaya J et al (2000) Postrevascularization recovery of fatty acid utilization in ischemic myocardium: a randomized clinical trial of potassium channel opener. J Nucl Cardiol 7:320–327

    Article  CAS  PubMed  Google Scholar 

  11. Nishimura M, Okamoto Y, Tokoro T et al (2014) Clinical potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention in hemodialysis patients. Nephron Clin Practice 126:24–32

    Article  CAS  Google Scholar 

  12. Workgroup K/DOQI (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45((Suppl 3)):S1–S153

    Google Scholar 

  13. Nishimura M, Hashimoto T, Kobayashi H et al (2004) Myocardial scintigraphy using a fatty acid analogue detects coronary artery disease in hemodialysis patients. Kidney Int 66:811–819

    Article  PubMed  Google Scholar 

  14. Nishimura M, Murase M, Hashimoto T et al (2006) Influence of diabetes mellitus on diagnostic potential of iodine-123-BMIPP imaging for coronary artery stenosis in hemodialysis patients. J Nephrol 19:481–491

    CAS  PubMed  Google Scholar 

  15. Akai K, Wang Y, Sato K et al (1995) Vasodilatory effect of nicorandil on coronary arterial microvessels: its dependency on vessel size and the involvement of the ATP-sensitive potassium channels. J Cardiovasc Pharmacol 26:541–547

    Article  CAS  PubMed  Google Scholar 

  16. Kasama S, Toyama T, Hatori T et al (2005) Comparative effects of nicorandil with isosorbide mononitrate on cardiac sympathetic nerve activity and left ventricular function in patients with ischemic cardiomyopathy. Am Heart J 150:477.e1–477.e8

    Article  Google Scholar 

  17. Barenbrock M, Spieker C, Laske V et al (1994) Studies of vessel wall properties in hemodialysis patients. Kidney Int 45:1397–1400

    Article  CAS  PubMed  Google Scholar 

  18. Amann K, Breitbach M, Ritz E, Mall G (1998) Myocyte/capillary mismatch in the heart of uremic patients. J Am Soc Nephrol 9:1018–1022

    CAS  PubMed  Google Scholar 

  19. Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127:757–763

    Article  CAS  PubMed  Google Scholar 

  20. Arnett EN, Isner JM, Redwood DR et al (1979) Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 91:350–356

    Article  CAS  PubMed  Google Scholar 

  21. Porter TR, Sears T, Xie F et al (1993) Intravascular ultrasound study of angiographically mildly diseased coronary arteries. J Am Coll Cardiol 22:1858–1865

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to offer their deep thanks to Naoto Inoue, MD of Sendai-Kosei Hospital, and Hiroshi Fujita, MD, and other staff of the Department of Interventional Cardiology of the Kyoto Second Red Cross Hospital for their assistance with coronary angiography, cardiac disease assessment, and coronary intervention.

Conflict of interest

None.

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Authors and Affiliations

  1. Cardiovascular Division, Toujinkai Hospital, 83-1, Iga, Momoyama-cho, Fushimi-ku, Kyoto, 612-8026, Japan

    Masato Nishimura

  2. Division of Anesthesiology, Toujinkai Hospital, Kyoto, Japan

    Yu Okamoto

  3. Division of Nephrology, Toujinkai Hospital, Kyoto, Japan

    Toru Takatani

  4. Division of Urology, Toujinkai Hospital, Kyoto, Japan

    Nodoka Sato, Masaya Nishida, Tetsuya Hashimoto, Satoru Yamazaki, Hiroyuki Kobayashi & Toshihiko Ono

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  1. Masato Nishimura
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  2. Yu Okamoto
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  4. Nodoka Sato
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  5. Masaya Nishida
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  7. Satoru Yamazaki
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  8. Hiroyuki Kobayashi
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  9. Toshihiko Ono
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Correspondence to Masato Nishimura.

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Nishimura, M., Okamoto, Y., Takatani, T. et al. Improvement of myocardial fatty acid metabolism by oral nicorandil in hemodialysis patients without coronary artery disease. J Nephrol 28, 227–234 (2015). https://doi.org/10.1007/s40620-014-0125-5

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  • DOI: https://doi.org/10.1007/s40620-014-0125-5

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