Korean Circ J.  2002 May;32(5):391-397. 10.4070/kcj.2002.32.5.391.

Comparison between Nicorandil and Adenosine in the Measurement of Coronary Flow Reserve Using a Doppler Guide Wire

• Jung HO
• Seung KB
• Kim PJ
• Ihm SH
• Kang DH
• Youn HJ
• Chae JS
• Kim JH
• Hong SJ
• Choi KB

• KMID: 2227266
• DOI: http://doi.org/10.4070/kcj.2002.32.5.391

Abstract

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is the capability of coronary arteriolar bed to dilate in response to increased cardiac metabolic demand. Nocorandil, a hybrid of ATP-sensitive K+ channel opener and nitrates, causes coronary vasodilation of both epicardial and resistance vessels. We investigated the feasibility and safety of nicorandil as compared to adenosine in the measurement of CFR using a Doppler guide wire.
SUBJECTS AND METHODS
We measured CFR in 26 consecutive patients (mean age 52+/-19 years, M:F=16:10) during coronary intervention with a 0.014-inch Doppler guide wire. We recorded the baseline average peak velocity (APV) and the hyperemic APV induced by intracoronary adenosine or nicorandil. The heart rate, mean aortic pressure and the time interval from maximal APV to baseline APV were also recorded.
RESULTS
There were no significant differences between APV, diastole/systole velocity ratio and CFR induced by adenosine and those induced by nicorandil (44.4 +/- 17.3 vs 45.5 +/- 17.6, p=0.78, 1.59 +/- 0.51 vs 1.57 +/- 0.52 p=0.78, 2.22 +/- 0.89 vs 2.27 +/- 0.94, p=0.36). The CFR and diastole/systole velocity ratio induced by nicorandil showed a strong positive linear correlation with those by adenosine (r2=0.77, p=0.0001, r2=0.83, p=0.0001). Adenosine significantly decreased the heart rate as compared to nicorandil =-25.5 +/- 9.7 vs -8.7 +/- 4.9 bpm, p=0.001). There were no differences in the changes of mean aortic pressure between adenosine and nicorandil (-7 +/- 9 vs -2 +/- 3 mmHg, p=0.17). Nicorandil prolonged the time interval from maximal APV to baseline APV compared to adenosine (194 +/- 62 vs 37 +/- 12 sec, p=0.001).
CONCLUSION
Nicorandil is feasible and safe for use in measuring CFR using a Doppler guide wire and may replace adenosine.

Keyword

Coronary flow reserve; Doppler; Blood flow velocity; Nicorandil; Adenosine; Ultrasonography

MeSH Terms

Adenosine*
Arterial Pressure
Blood Flow Velocity
Heart Rate
Humans
Nicorandil*
Nitrates
Ultrasonography
Vasodilation
Adenosine
Nicorandil
Nitrates