Effects of nitroglycerin on echocardiographic measurements of left ventricular wall thickness and regional myocardial performance during acute coronary ischemia.

Komer, R R; Edalji, A; Hood, William B.

doi:10.1161/01.cir.59.5.926

Cited by 30 publications

(5 citation statements)

References 35 publications

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“…These authors also observed that the ischemia-induced impairment of segmental wall motion in the anterior segments was not changed by nitroglycerin. These results on global and regional ventricular function during transient ischemia are in agreement with previous experimental studies in open-chest dogs evaluating the effects of intravenous nitroglycerin on regional left ventricular performance during brief periods of coronary occlusion [14]. These investigators concluded that nitroglycerin does not improve regional myocardial function in acutely ischemic myocardium and that the nitroglycerin-induced decrease in preload is probably entirely due to the peripheral effects of the agent.…”

Section: Nitroglycerin and Left Ventricular Dysfunctionsupporting

confidence: 89%

The effects of pretreatment with nitroglycerin on ischemic left ventricular dysfunction during coronary angioplasty

Amende

Herrmann

Simon

et al. 1991

Cardiovasc Drug Ther

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To evaluate the degree to which nitroglycerin reduces myocardial ischemia and dysfunction induced by transient coronary occlusion, 19 patients were studied during coronary angioplasty of the left anterior descending coronary artery. After a control occlusion of 60 seconds, 0.2 mg nitroglycerin was administered intravenously and the occlusion was repeated for 60 seconds. Before and during the occlusion period, pulmonary capillary wedge pressure was measured, the intracoronary ECG was recorded, and ventricular volumes, ejection fraction, and regional systolic shortening were obtained by digital subtraction angiography. Nitroglycerin caused a significant fall in pulmonary capillary wedge pressure before (10 vs. 7 mmHg) and at 60 seconds occlusion (18 vs. 14 mmHg), but did not significantly delay the rise in wedge pressure (37 vs. 44 seconds). End-systolic left ventricular volume at 60 seconds of occlusion was reduced by nitroglycerin (77 vs. 68 ml), whereas regional shortening of the ischemic segments remained unchanged (22 vs. 23%). Nitroglycerin did not delay the onset of ischemic ST-segment elevation (14 vs. 14 seconds) and had no effect on the changes of ST elevation in the intracoronary ECG (1.9 vs. 1.9 mV). These findings suggest that intravenous nitroglycerin reduces filling pressure and slightly improves left ventricular global function during acute coronary occlusion. Nitroglycerin, however, has little effect on ischemia-induced regional dysfunction and on ST-segment elevation in the intracoronary ECG.

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Section: Nitroglycerin and Left Ventricular Dysfunctionsupporting

confidence: 89%

The effects of pretreatment with nitroglycerin on ischemic left ventricular dysfunction during coronary angioplasty

Amende

Herrmann

Simon

et al. 1991

Cardiovasc Drug Ther

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“…In a previous study we have shown that a decrease in arterial blood pressure has only very minor effects on myocardial wall thickening (32) but underestimates contractility changes estimated from maxLVdP/dt. This study also demonstrates that determination of variables such as EDT, EST, maxT and swt (5,16,33) which are frequently used for the ,quantification of regional myocardial function during ischemia are not adequate for the description of positive inotropic interventions in normal perfused hearts, especially when factors that determine end-diastolic volume and therefore EDT are also affected.…”

Section: Discussionmentioning

confidence: 88%

Systemic and regional myocardial responses to AR-L 115 BS, a positive inotropic imidazo-pyridine, in the absence or in the presence of the bradycardiac action of alinidine

1981

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SummaryThe effects of the imidazo-pyridine AR-L 115 BS on global and regional myocardial function were investigated in anesthetized pigs in the absence and in the presence of the bradycardiac action of alinidine. AR-L 115 BS (0.1-0.8 mg 9 kg -1 9 rain -1) increased myocardial contractility (up to 75 %) and reduced preload (50 %) and afterload (50 %) in a dose-dependent manner. These changes were accompanied by moderate increases in heart rate (up to 20 %). The increase in cardiac output was only moderate (20 %), due to the reduction in preload. Renal blood flow increased slightly, but coronary blood flow was not significantly affected, due to the marked decrease in coronary vascular resistance (up to 50 %). Regional perfusion was not impaired as the endo/epi flow ratio was not affected and the coronary venous 02-saturation increased slightly but significantly. Myocardial wall thickness tracings (ultrasound principle) showed some pronounced changes. The positive inotropic action of AR-L 115 BS were best reflected by the changes in the velocity of wall thickening (up to 90 %, P < 0.001), and the timing of the occurrence of maximal wall thickness (maxT) with respect to aortic valve closure, as maxT, which occurred 5-10 msee after aortic valve closure during base line, preceded aortic valve closure with 45 msee after AR-L 115 BS (P < 0.001).Since the adverse effects of positive chronotropy on isehemie myocardium are well documented, AR-L 115 BS was also investigated in combination with alinidine, an agent which has predominantly negative chronotropie properties. This study revealed that alinidine did not interfere with the positive inotropic action of AR-L115BS but mainly reduced heart rate. Consequently, combination of the two drugs, which resulted in an improved myocardial function at a lower O2-demand, may offer an attractive addition in the treatment of myocardial pump failure.

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“…They found that stunned myocardium responded to both intravenous epinephrine and postextrasystolic potentiation, thus demonstrating considerable functional reserve. In a similar model, it was observed that during transient occlusion of the left anterior descending there was end-diastolic thinning and marked reduction of the systolic thickening in the ischemic zone [19]. Infusion of nitroglycerin did not appear to change systolic wall thickening.…”

Section: Myocardial Contractility As a Measure Of Viabilitymentioning

confidence: 81%

Role of myocardial viability in the improvement of cardiac function after revascularization

1996

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Coronary artery disease, associated with a large myocardial infarction, is the cause of heart failure in approximately 50% of current clinical series. The possibility of revascularization, using either coronary bypass surgery or angioplasty, in these patients increases the importance of the determination of viable, but hibernating, myocardium. Positron emission tomography, thallium reinjection, and dobutamine stress echocardiography are the current techniques available for the determination of hibernating myocardium. Thallium reinjection has the greatest sensitivity, but echo dobutamine has greater specificity. Improvement can be expected in patients who have more than 30% of their myocardium demonstrated to be viable by any of these techniques. Improvement in function occurs early after revascularization. It is suggested that 20-40% of patients with congestive heart failure due to previous myocardial infarction, may achieve a clinical improvement by revascularization. There is also evidence to suggest that the recurrent morbidity and mortality events are affected by revascularization. Key Words. myocardial viability, myocardial revascularization, congestive heart failure, coronary artery diseaseCoronary artery disease remains one of the major causes of heart failure. In three of the largest randomized heart failure treatment studies, coronary artery disease was the etiology responsible for approximately 50% of all patients. In the Cooperative New Scandinavian and Enalapril Survival Study (CON-SENSUS), coronary artery disease was present in 73% of patients [1]. A history of previous myocardial infarction was elicited in 47%. The remaining patients were made up of idiopathic dilated cardiomyopathy in 15%, valvular heart disease in 42%, and hypertension in approximately 20%. In the two Veteran's Administration's Heart Failure Studies (V-HeFT) [2], coronary heart disease was present in 44-53%, a previous myocardial infarction in 42% and 47%, and a history of hypertension in 41% and 47%, respectively. In the Studies of Left Ventricular Dysfunction (SOLVD) [3], 80% of the patients had a previous myocardial infarction. In a recent study of 224 patients awaiting cardiac transplantation, 89 were considered to have idiopathic cardiomyopathy and 121 were diagnosed as having coronary heart disease [4].In the past, the only recognized way to improve congestive heart failure in patients with coronary heart disease was surgical aneurysmectomy. Improvement of cardiac function has not been considered to be an important reason to perform coronary bypass surgery. Nevertheless, many authors have duplicated the initial experience of Rahimtoola [5], who observed that selected patients with apparent severe myocardial dysfunction improved after revascularization. These patients were considered to have a myocardium that was barely subsisting on diminished coronary blood flow. Left ventricular dysfunction was considered to be secondary to a decrease in the supply of nutrients. When flow was restored to this myocardium, function improved....

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Effects of nitroglycerin on echocardiographic measurements of left ventricular wall thickness and regional myocardial performance during acute coronary ischemia.

Cited by 30 publications

References 35 publications

The effects of pretreatment with nitroglycerin on ischemic left ventricular dysfunction during coronary angioplasty

The effects of pretreatment with nitroglycerin on ischemic left ventricular dysfunction during coronary angioplasty

Systemic and regional myocardial responses to AR-L 115 BS, a positive inotropic imidazo-pyridine, in the absence or in the presence of the bradycardiac action of alinidine

Role of myocardial viability in the improvement of cardiac function after revascularization

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