Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure.

UNLABELLED 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). CONCLUSION 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.