The American journal of cardiology
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Nicorandil is a new compound that has shown potent vasodilator activities on venous and arterial beds in experimental pharmacology. This study was designed to evaluate the magnitude and the time course of hemodynamic effects of different doses of nicorandil in congestive heart failure. Eleven patients with severe congestive heart failure (New York Heart Association class III or IV), with a cardiac index less than 3 liters/min/m2 and a pulmonary wedge pressure greater than 15 mm Hg were enrolled in the study. ⋯ Calculated systemic vascular resistances decreased by 36 +/- 6% and heart rate did not significantly change. Nicorandil was well tolerated. Thus, the results of this first study of nicorandil in congestive heart failure demonstrated the unloading action of this compound on the failing heart, leading to an improvement in cardiac function; further investigation of nicorandil in this therapeutic area is needed.
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Multicenter Study Clinical Trial
Clinical characteristics and natural history of survivors of pulmonary congestion during acute myocardial infarction. The Multicenter Postinfarction Research Group.
Although pulmonary congestion during acute myocardial infarction (AMI) is recognized as an important adverse event, the detailed clinical features, natural history and predictive value of standard diagnostic tests in such patients have not been well characterized. As part of a multicenter prospective postinfarction trial, 123 patients with pulmonary congestion during AMI, who survived and were discharged from the coronary care unit, were studied. These patients were compared with similar patients who did not develop pulmonary congestion. ⋯ In patients with pulmonary congestion, ejection fraction (dichotomized at 30%) and exercise testing were the most discriminating tests in risk stratification. An ejection fraction greater than 30% and completion of the exercise test was associated with a 7% mortality while an ejection fraction less than 30% and inability to take or complete the exercise test was associated with a 44% 1-year mortality. A greater incidence of reinfarction, ischemia during exercise and ischemic events at the time of death in the pulmonary congestion group suggests that ischemia may be an important factor in this high risk category.