Nicorandil improves coronary slow flow through regulating plasma nitric oxide and endothelin-1 level

Ma Min; Zhu Ye; He Yong

doi:10.3760/cma.j.issn.1673-4777.2017.06.002

Abstract：Objective To investigate the curative effect of nicorandil on coronary slow flow (CSF).Methods A total of 78 patients with chest pain were included from January 2014 to January 2015.all patients had coronary angiography in West China Hospital,Sichuan University.According to results of coronary angiography,the patients were divided into CSF group [CSF in left anterior descending (LAD),48 cases] and control group(normal coronary artery,30 cases).Global and regional function of left ventricle supplied by LAD were measured using Doppler echocardiography and two-dimensional speckle tracking echocardiography within 24 h after coronary angiography.Concentrations of plasma nitric oxide(NO) and endothelin-1 (ET-1) were determined.The CSF group was treated with nicorandil(5 mg/time,3 times/d) for 3 months and left ventricular function and plasma NO,ET-1 levels were tested after treatment.Results Before treatment,there were no significant differences of left ventricular ejection fraction,left ventricular end-systolic diameter and left ventricular end-diastolic diameter between groups(P ＞ 0.05);the late diastolic peak flow velocity(A) in CSF group was significantly higher than that in control group,the early diastolic peak velocity(E) and E/A ratio in CSF group were significantly lower than those in control group[(75.2 ±9.2) cm/s vs (68.8 ±9.9)cm/s,(66.3 ± 10.1)cm/s vs (81.5 ± 11.6)cm/s,(0.89 ± 0.23) vs (1.42 ± 0.40)] (P ＜ 0.05 or P ＜ 0.01);the peak longitudinal strain rates of 4 myocardial segments supplied by LAD in CSF group were significantly lower than those in control group (P ＜ 0.05);plasma NO level in CSF group was significantly lower and ET-1 level was significantly higher than those in control group [(28 ± 5) μmol/L vs (37 ± 4) μmol/L,(11.4 ± 1.5) ng/L vs (6.8 ± 1.2) ng/L] (P ＜ 0.01).After treatment,E value(74.3 ± 1.3)cm/s,E/A ratio(0.92 ±0.22),peak longitudinal strain rates and plasma NO level[(30 ± 5) μmol/L] in CSF group were significantly higher and plasma ET-1 level[(9.1 ± 1.1)ng/L] was significantly lower than those before treatment (P ＜ 0.01 or P ＜ 0.05).Conclusion Nicorandil may improve CSF through increasing plasma NO and reducing ET-1.